670364.pdf. R
BUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAIA (OR NAME OF BUSINESS)
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NON -RESIDE TIA.L
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WALL
ElALTER
EXCAVATE
F] OR FILL
FENCE
( x Ft.)
.......... ..........
REPAIR
PRE -MOVE
1:1 INSP.
swill
POOL
ES
NUMBER OF
DWELLING
UNITS
ON KROLL MAP NO.: PERMIT
I NUMBER 670364
JOB ADDRESS dad,
Tit-)-t :�Lv A
SIDE YARD SETISAU& 13TREET ) SETBACK nNAR YARD SETBACK
'k— 8 CP!9- M 11 C
1:2 M 1, t-4 1,14 _.
USE ZONE LOT A.REA VACANT SITE
[] YES [] No
VARIANCE N-'Mff I
STREET 141W
EXISTING STnEE`r R/W .44�..77. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W PT. ....... 0.1" .
REMARKS
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CKED BY S
Z
METER SIZE SERVICO "'ZIP C"ARANCE CHEC BY
131
REMARKS
(j YES F] NO
rMBER
[] YES [3 No
Valuation
Fee
Receipt No.
rian Check No .....................
PROPOSED USE
BUILDING
OT PLAN (Indicate B setbacks, abutting streets)
PLUMBING
S7 o 0
HEAT & GAS LINE
Z
PENCE
t
SIGN
IN
RETAINING WALL
�3 3 13 J R.
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
79,9-(-)
I hereby acknowledge that I have read this application; that the In.
formation given In correct; and that I am the owner, or the duly author.
ized agent of the owner. I agree to comply with city and state laws regu-
AT=NTION
APPLICATION APPROVAL
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 PER31IT
This application is not a permit until
relatlng to Workmen's Compensation Insurance.
AUTHOnIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit one Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
shall be completed in ninety days: 31OVED-IN BUILDIN08 shall be com-
knowledged in space Provided.
pleted in SIX months.)
9
SIGNAY9RE (OWNER O"GENT) D TO SIGNE
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INSPECT10N
DEPARTMENT
P. le Of-
Dll��y
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CITY OF
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to Plan Check Fec
EDMONDS
DATE
NOTE: Applicant Sdject
PR 6-1107
This Permit covers work to be done on private property ONLY.
domain (curbs, sidewalks, driveways,
Any construction on the public
FILE
marquees, etc.) will require separate permission.
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