680045.pdf. .. ........
BUILDING DEPARTMENT Applicant M
PERMIT APPLICATION I Inside Heavy Lines
8
6802— 174th. S. W.
Frederick P1
Pr
or
1POSTED ON KROLL MAP NO-: PERMIT 680045
/ �Z/ V I NUMBER
JOB ADDRESS
4 ? e 6
SIDE ARD SETUAM STREET SETBACK kWAR YARD
I/Y SETBACK
USE Z LOT TUMAZ�l VACANT SITE
� R T y 1 0 YES 13 N4
RESIDENTIAL
GAS
LINE
NEW
NON-RESIDENrIAL
SIGN
ADD
RETAINING
F1
WALL
ALTER
DEMOLISH
EXCAVATE
OR FILL
F1
FENCE
Ft.)
. ........
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF
T
DWELLING
UNITS
EXISTING STREET n/W DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... I". .... ....... ITT.
13 YES [] NO
Plan Check No ......... .. ...... .
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbac , �abuttln�g streets)
PLUMBING
BEAT & GAS LINE
FENCE
SIGN
N
IRETAINING
30�
WALL
vy, rn 1 r4
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby Acknowledge that I have read this &PPIlCatl0u; that the In-
formatlon 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-
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 PERBUT
relating to WorkmeWo Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DE5101JTIONS which
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
FIG —NATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit covers work to he done an private Property ONLY.
Any construction on the pubtlo domain (curbs, sidewalkep driverwiLysp
W&Muecs, ate.) will require separate permission.
.:10
[3 YES E3 NO
Valuation I Foe
s,
I
NO.
jt4fRTjZ'j!=r1
APPLICATION APPROVAL -
This application Is not a pernilt until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Itnowledged in space provided.
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0ii.- - IV 0 -
FILM des k'