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POSTED 6N—XROLL MAP NO..' PERMIT
PARTMENT
Applicant Fill
/10 NUMBER
680027
LICATION
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SIDE YARD SETBACK
STREET 13ETBJLC
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TELEPHONE NUMBER
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HEIGHT
BUEDING A—REA
VARIANCE jjUMBER
PLOT PLAN APPROVED
ST MET R/w
EXISTING STREET a PROPERTY
R/W DEFICIENCY THI
TELEPHONE NUMBER
COMP. PLAN ST. R/W
FT.
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NOE NUMBER
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RESXDENTLA
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GAS
LINE
NEW
NON-RESIDI TIAL
SIGN
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RETAINING
WALL
DEMOLISH
EXCAVkTE
FENCE
ALTER
F�
OR FILL
( X Ft.)
........ . ..........
REPAIR
1:1
PRE -MOVE
1 NSP.
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POOL
IUMBER OF STORIE13
NUMBER OF
-2
DWELLING
UNITS
RE Z TYPE OF CONST;�TION
STREET
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1 [3 YES
ECXAL INSPECTOR REQUIRED
OCOUPANCYAOUP
YES _,r-wo
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Plan Check No ..................
PROPOSED UBE
BUILDING
4 Q ej - —
Q PLOT PLAN (104 cato Building setback firabutting streets
PLUMBING
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HEAT & GAS LINE
FENCE
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SIGN
N
RETAINING WALL
SWIMIUNG 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 Wn the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws regu.
ATTENTION
luting construction; and in doing the work authorized thereby. no person
will be employed in violation of the Labor Code of the State Of WaBhlu9tOU
TIUS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY TIM
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com.
pleted In six months.)
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—891ONAMU—RFoXOWNER Oft NT)
DATE SIGNED
INSPECTION
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DEPARTMENT
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CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PH 0-1101
This Perrnft covers work to be done m private property ONLY.
Any oonstruction on the public domain (curb$$ sidewalks, driveways,
Marquees. etc.) %vill require separate permission.
Valuation Fee Receipt No.
—7'
66
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.
BIG RE
70
DATE
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