670455.pdfPOSTED ON KROLL MAP NO.: PERMIT
NUMBER "70455
-I WING DEPARTMENT
8 Applicant FIR
J N DEDAUT ADDILFATI H Inside 11cavy Lines
JOB ADDRESS
NAME (OR NAME OF BUSINESS)
Da lwv /'I- -e 11�z
21AILING ADDRESS
C,
ADDRESS
�/_57� 417 M
21-
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of property (Show Below or AttELC11 Your it
035 - 4<
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YARD ShTEMACIC
43
ST EET SET13ACK
REAlt MR) SET -BACK
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USE
ZONE
AIIEA
-VACANT SITE I
[3 YES NO
I UTM.nTMn AnW�
I VARIANCle NUAWEn N
FX1 NEW
RESIDENTIAL
F
GAS
LINE
NON-RESIDENTIAL
SIGN
DADD
RETAINING
WALL
DEMOLISH
ALTER EXCAVATE
OR FILL
PENCE
( x Ft.)
.......... ..........
REPAIR PRE -MOVE
INSP.
swim
POOL
I NUMBER OF
DWELLING
UNITS
fATURE OF WORK TO BE DONE
ROVED
=R / mv - - - OFERTY
a NO STREET R/W IrT. DEFICIENCY THIS PH
COMP. PLAN ST. R/W
EBLARKS
D BY
CHEC-lip z
LKS
CONNECTION VERIFIED BY
TEST PERMT fU
[J YES
TYE-IS
Plan check No ............. ... ...
_FAOPOSED USE
BUILDING
IFEOT PLAN (Indicate Building setbacks, abutting streets) PLUMBING
HEAT & GAS LINE
FENCE
t SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowled90 that I have read this application: that the In-
formation given to 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 regL- ATTENTION
I&tlng construction; and in doing the work authorized thereby. no person
will be employed in violation of the Labor Code of the Etwe of Washington TIHS PERMIT
relating to Workmen'a Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORR. NOTED
shall be Completed In ninety days: J#IOVED-IN BUILDINGS shall be com-
pleted in six months.)
INSPECTION
JIG ATURE (OWNER OR AGENT) DATE N
DEPARTMENT
_(4 CITY OF
EDMONDS
NOTE: Applicant Subject to Plays Check Fee Pit 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
valuation
[] YES ci�_ �O
Fee
7 -3 - (9 �� 14- ;3 L
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-
Imowledged in space provided.
DIRECTOWS, SIGNATI!I!�/
I
FILE
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