670576.pdf. . . .. . . . . . ........ . .
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAfE OF BUSINESS)
14/1
CITY TELEPHONE NUMBER
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f Property (snow Below or Att[LCU
a
DNEW
ig-*IDENTIAL
R
GAS
LINE
0
NON-RESIDENTIAL
SIGN
DADD
DDEMOLISH
RETAII�IING
WALL
E!—J-'ALTMR
EXCAVATE
FENCE
F�
OR FILL
( X Ft.)
M REPAIR
11
PRE -MOVE
INSP.
El
.......... ..........
swim
POOL
DWELLING
UNITS
R'Ic� dq a t�acl e Coo Ve
r __Z7
a/ k set
GO M
r FLA-N (Ind cate Building setbacka, abutting streets
ZrIld . 5. W -
Al
fist
I hereby acknowledge that I have read this application; 1hat the in-
formation given In correct; and that I am the owner, or the duty allthOr-
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 Workmen's Compensation Insurance.
NOTE: Permit Limit One Your (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
ilG ATU (OWNER ORAGYNY)/ DATEIGNE
7, 7
NOTE: Applicant Subjcct to Plan Cbech Fce
This Ferndt covers work to be done art private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
rmurquees, etc.) %vIll require separate pemission.
KROLL MAP NO-: PERMIT
NUMBER 670576
IS
2�6c,-- 8C LAJ
SETBACK B R ET SETBACK nEAn YARD RETBACK
-2.5,% Z15
1 LOT AREA VACANT SITE
1 [3 YES 0 NO
I 13UILDING MM—A. I VARIANCE NUMBER P4
�� <f
STREET R/W
EN38TING STREET R/W ............ FT. DEFICIENCY TH113 PROPERTY 0
COUP. PLAN ST. R/W ............ FT. .......... FT.
REMARKS
BY
[3 YES
Plan Check No .......
Cj YES [3 NO
Fee I Receipt No.
BUILDING
PLUMBING
& GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
CIO
ATTENTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
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.
DIRECTOR'S SIGNATURE
DATW-
FILE
I