670376.pdfBUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Ileavy Lines
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'PINEBW If
7_108—TOD ON KROI 1,
MAP NO.:
PERMIT
I NUMBER
670376
/ /
JOB ADDRESS
131DE YARD SETBACK STREE' BET13ACIL
REAR VARD SET' - 3ACK
USE ZONE
LOT AJUUA
--L
VACAJTr SITE
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I
YES 0 NO
NCE NUMBEER
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EXISTING STREET R/W ............ M. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ Fr- ........... In.
1% A
Y
—61—A9,
TYPE
[] YES [] NO
<I
a�ESIDENTIAL
GAS
LINE
NEW
N-RESIDENTIAL
SIGN
ADD
RETAINING
WALL
DEMOLISH
E] ALTER
EXCAVATE
OR FILL
PENCE
( .......... x .......... Ft.)
REPAIR
PRE -MOVE
INSP.
0
SWIM
POOL
;UMBER OF STO!ffEs I NUMBER OF
DWELLING
UNITS
a
- IPlan
Check No .....................
PROPOSED WIN
BUILDING
PLUMBING
—prUT PLAN '(Indict, Building setbacks, abutting streets)
14
HEAT & GAS LINE
FENCE
.4,
t
SIGN
co
RETAINING WALL
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 duly 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
ONLY THE
NOTE: Permit Limit One YeOr (Except DE15101,11TION'S which
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
INSPECTION
18110INAT (OWNER Zw—,A3im)
DATE 131 )NED
DEPARTMENT
CITY OF
EDMONDS
Applicant Subjcct to Plan Check Fee
NOTE:
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the 1,Ubl[C domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
El YES E3 NO
Valuation I Fee
101
Z
2.001
APPLICATION 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-
knowledged in space provided.
9 1 1 11 1 1�1
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FILE