680051.pdf............. — ------- ____ ..... .. —_.._1_1 ......
POSTED ON KROLL MAP NO.. PERMIT
BUILDING DEPARTMENT Applicant Fill I NUMBER
PEWT APPLICATIO14 Inside Heavy Lines JOB ADDRESSp 7/76 0 7.
NA?f (OR NAME OF BUSINESS)
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NEW
RESIDENTIAL
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NON-RESIDENTrAL
SIGN
RETAINING
WALL
DEMOLISH
EXCAVATE
FENCE
ALTER
OR FILL
Ft.)
PRE -MOVE
( ........ x . ........
SWIM
REPAIR
INSP.
POOL
NUMBER 5V
DWELLING
UNITS
680051
I 1 0
USE ZONE LOT AREA VACANT SITE
1 1 El YES 13 NO
_XE I GWr I BUILDING AREA. I VARIANCE NUMBER a,
EN38TING STREET R/W DEFICIENCY THIS PROPERTY
[I YES [j NO
Plan Check No ............ .......
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting atreets)
PLUACRING
HEAT & GAS LINE
FENCE
t
SIGN
RETAINING WALL
SWIMMING 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 in 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.
lating construction; and in doing the work authorized thereby, no person
ATTENTION
will be employed In violation of the Labor Coda of the State of Wambtngton
TIU13 PERMIT
relating to Workmen's Compensation Insurance.
AUTHOMZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in,nLx month!,�
INSPECTION
rl—G—NA (ojy;i= Oki AGENT)
DATE SIGNED
I
DEPARTMENT
I
L)— / 4� ?
I CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
1?R 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the publia domain (curbs, sidewalks, driv&w*Ys,
marquees, ate.) win require separate permission.
El YES 13 NO
5MV
APPLICATION APPROVAL
No.
This application Is not a permit until
signed by the Building Official or his Dell-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
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