680046.pdffro-W—XED ON KROLL MAP NO.: PERMIT
DING DEPARTMENT N%tr%o 620046
Applicant FW t
Inside Ifeavy Lines
JOB ADDRESS W WWV"V. %.f� b%oovry
MIT APPLICATION
[OR NAME OF BUBINEBB) ;94
I REAn YARD BETBACKI
-T SETBACI_
Finm YARlY 13ETBACIC I STREE C
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10 A.DDRESS
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ETINUW
2_'�ESIDENTIAL
0
GAS
LIN I E
DADD
NTJ
NON-RESIDE�NTIAL
SIGN
RETAINING
DDEMOLISH
WALL
ALTER
EXCAVATE
r_1 OR FILL
FENCE
( x Ft.)
........ . . ........
REPAIR
PRE MOVE
F1 INSP.
swim
POOL
rUMBER OF STORI9B_
NUMBER OF
DWELLING
UNITS
z
0
PROPOSED UBE
PLOT-PL&N _(Indicate Building setbacks, abutting streets)
to
0
.CANT BITE
YES 13 NO
,RIANCE NUMBER I oo
CISTING STREET R/W .......... rT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W..-..-...rr. ... ........ 1T.
0 FIRE ZONE I TYPE OF CONSTRUCTION
0 YES 0 NO
PLAN CHECKED BY
REMARKS
Al :10f—
Plan Check No .... ........ .......
BUILDING
PLUMBING
HEAT A GAS LINE
t
13IGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thlx application; that the In.
formation given In correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state laws regu-
lating construction; wad In doing the work authorized thereby, no person
AWENTION
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen'n compensation Insurance.
AUTHORIZES
NOTE: Permit Cimit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com.
p lete
.A)n sl� monlh3o
INSPECTION
DEPARTMENT
CITY OF
DATE SIGNED
:2 -134&'
EDMONDS
NOTE: YApplicant Ubject to Plan Check Fee
PR 6-1107
This permit covsrs work to be done on private property ONLY.
Arty construction on the public domain (curbs, sidewalks, driveways,
marquees, ate.) will require separate permission.
Valuation
[] YES [:] NO
4�.
I z T( 0 0 1
No.
APPLICATION APPROVAL
This application Is not a permit until
Signed by the Building Off lcial or his Dep-
uty; and fees are paid, and receipt Is ac-
Imowledged in space provided.
: DLnE
7 OR'S SIONAT y RE
. 47