670362.pdfUILDING DEPARTMENT
TERMIT APPLICATION
NAM
(OR NAME OF BUSINESS)
Logs" Denc,
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21 S—
VA
POSTED ON KROLL MAP NO.: PER IT
NUMBER 670362
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inside Heavy 1,11nes JOB ADDRE88
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EPHORE ONIK
412—lo 99
SIDE YARD
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USE NE
HEIGHT
SETBACK
STREET SETBACK
R19A.It YARD SETBACK
LOT AREA
VACANT S]TE
YES 1
13 NO
B ING AREA
I Aw
STRW B1W
EXISTING STREET R/W ............ FT. DEFICIEN ey THIS PROPERTY
HONE NUMBOF—
COUP. PLAN ST. R/W ............ FT.
REMARKS
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ukiECKED BY
METER SIZE SERVICE Si CHECWDD BY
CLEARANCE
HONE NUMBER
REMARKS
ACENSE NUMBER
WRESIDENTIAL
El
GAS
LINE
NEW
NON-RESIDENTIAL
F�
13ION
DDEMOLISH
M
RETAINING
WALL
EXCAVATE
FENCE
ALTER
M
OR FILL
( x Ft.)
REPAIR
M
PRE -MOVE
INSP.
.......... ..........
swim
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
Z
Q YES
Plan Check No .....................
PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
FENCE
00
7ZI—
t
SIGN
N
RETAINING WALL
k3o
04
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given is correct; and that I am the owner, or the duty author-
Ized agent of the owner. I agree to comply wIth city and state laws regu-
ATTENTION
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE31OLITIONS which
ONLY TIEE:
WORK NOTED
shall be completed In ninety days; BIOVED-IN BUILDINGS shall be com-
pleted In nix months.)
3IGNATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plait Check Fee
PR 6-1107
—ible Permit covers work to be done on private property ONLY.
Any constructicni on the public domain (curbs, sidewmIks, driveways,
njarqueos� etc.) will require separate permission,
[] YES
No.
5�,
I 70,M V3F;LE
APPLICATIOM APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
FILE
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