670512.pdfV�
POSTED ON KROLL MAP NO.: PERMIT
Rilitnimr. nFP1kRTMFNT INUMBER 670512
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ERMIT APPLICATION
IM (OR NAME OF BUSINESS)
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JIJNG ADDRESS
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Mm
Applicant Fill
Inside Heavy Lines
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ITT TELEPHONE NUMBER
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TATE LICENSE NUMBER CITY LICENSE NUMBJ
,ogdl Description of Property (Show Below or Attach Four Copies)
0 NEW
14 RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
I
D
SIGN
RETAINING
.
DEMOLISH
WALL
ElALTER
EXCAVATE
PENCE
0
OR FILL
( X Ft�)
REPAIR
PRE -MOVE
.......... ..........
swim
INSP.
POOL
rumBER OF STORIES
NUMBER OF
DWELLING
UNITS
TATURE OF WORK TO BE DONE
_/__
40
(o tj & te-
DDRESS
_411 d2 0.
USE ZONE LOT AREA VACANT SITE
[3 YES [3 NO
P
HEIGHT I BUILDING AREA I VARIANCE N M R
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY 0
COMP. PLAN ST. R/W ............ FT. ....... .... 17.
REMARKS ii
0
Z
CHECKED BY
METER SIZE I SERVICE SIZE I CLEARANCE CHECKED BY
REMARKS
[] YES [3 NO
Plan Check No .....................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUAMNG
HFAT & GAS LINE
PENCE
t
SIGN
N
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 sun 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
NOTE: Permit Limit One Year (Except DEMOLITIONS %vhlch
ONLY TIEE
WORK NOTED
shall be completed In ninety days; 31OVED-IN BUILDINGS shall be com-
pleted in six months.)
SIGNATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6.1107
This Permit covers 1vork to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveivays,
marquees, etc.) will require separate permission.
[I YES [3 NO
Valuation I Fee
00
No.
1 3 .,�) 0 1 q 09
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.
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FILE
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