670566.pdf70—WrED ON KRO" MAP NO.: PERMIT
BUILDING DEPARTMENT ""I NUMBER 670566
1 Applicant Fill I
PERMIT APPLICATION Inside 7=avy Lines JOB ADDRESS
NAME (OR NAME OF BUSINESS) ty 93AX Wy,)�7
SIDE YARD SETBACK I STRIFE—TSETBACK REAR YARD SETBACK
�'- 1CITY
' 60 J-- -
F-1 NEW
RESIDENTIA
0
GAS
LINE
NON -RESIDE TIAL
F�
SIGN
D""
RETAINING
0
DEMOLISH
WALL
0
EXCAVATE
PENCE
ALTER
0
OR FILL
El
( x Ft.)
REPAIR
1:1
PRE -MOVE
INSP.
.......... ..........
swim
POOL
ES
NUMB191% Ulf
DWELLING
UNITS
_V8E _ZONE LOT A.REA VACANT SITE
1 1 13 YES [3 NO
WVMUM I BUILDING AREA I VARIANCE NUMBER ;W
EXISTING STREET R/W ... ........ FT.
COUP. PLAN ST. R/W ............ Fr.
TYPE OF
[:] YES [] NO
Plan check No ...........
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
t SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
I EXCAVATION OR FILL
ITOTAL A31OUNT 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.
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
relating to Workman-8 Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
Applicant Subject to Plan Cbeck Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways.
nutrquees, etc.) will require separate permission.
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
DEFICIENCY THIS PROPERTY
........... In.
Valuation
El YES 13 NO
No.
I It o o I (4(s-(a'
APPLICATION APPROVAL
This application is not a perinit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
" 1�7 �
FILE