670575.pdfBUILDING DEPARTMENT I Applicant IM
.PERMIT APPLICATION Inside Heavy Linen
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POSTED ON KROLL MAP NO.: PERMIT
NUMBER 670575
JOB ADDRESS
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E YARD BET13ACK STREET SETBACK REAR YARD SETBACK
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US&ZONZ "Or AREA VAC�w SITE
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I BUILDING AREA 1 VARIA.NCE NUMBIGH
45-7
STREETg�*M
NUMBER EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. —
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Lsgw Dasarlption or rroperty (Shovy
PERO. TZIT PZRIPT VMBER
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OIRESIDENTIAL
&JP'
GAS
LINE
NEW
NON-RESIDENTLAL
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SIGN
RETAINING
WALL
ALTER
DEMOLISH
EXCAVATE
OR FILL
PENCE
( �x Ft.)
......... ..........
REPAIR
PRE -MOVE
INSP. ''
SWIM
POOL
DR OF
DWELLING
UNITS,
qATURE OF WO!UE_TO BE DONE
U101
Plan Check No ............. .....
PROPOSED FU19
BUILDING
t
PLOT PLAN (Indicate Building setbacks, abu ting streets)
FLUIESING
HEAT & GAS LINE
0
PENCE
SIGN
RETAINING WALL
SWIM NO 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 duty author-
ized agent of the owner. I agree to COMPlY With city and state laws regu-
ArMNTION
I&Ung 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.
AUTHORnEll
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUHMINGS shall be com-
pleted in six months.)
SIGNATURE (0 111 OR AUJUS-K) DATE ONE
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PH 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.
[3 YES [] ?;0
Valuation I Fee
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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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