680053.pdf.... .........
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POSTED ON KROLL MAP NO-: PERMIT
680053
LDING DEPARTMENT Applicant Fill
NUMBER
inside Heavy Lines
RMIT APPLICATIO14 I
JOB ADDRESS
BUSINESS)
T 'NAME
71 ')__0
),
(OR OF
67
SIDE YARD SETBACK
STREET SETBACK
HEAR Y&KV SETBACK
aNG ADDRESS
USE ZONE
LOT AREA
VACANT SITE
Tig"PHOME —NUMBEIR
[3 YES 13 NO
, 41,0b5
HEIGHT
BUILDING AREA
VARIANCE NUMBER
P,
PLOT PJ�AN XPPROVED
STREET It/w
EXISTING STREET R/W
........... FT -DEFICIENCY THIS PROPERTY
I TELEPHONE NUMBER
COMP. PLAN ST. R/W
.......... FT .
REMARKS
Z
BY
METER SIZE SERVICE SIZE CLEARANCE CRECKE
MZNBE NUMBER CITY �CENSE �NUMBER
I scription of Property (Show Below or Attach Four Copies) REMARKS
A - - � - , j _\'
GAS
FINEW RESIDENTIAL LINE
NON-RESIDENTL4,L SIGN
E] RETAINING
DEMOLISH WALL
ALTER EXCAVATE PENCE
OR PILL ( ........ . x .......... Fit.)
FREI-MOVE SWIM
REPAIR INSP. El POOL
0 YES 0 NO
PLAN CHECKED BY
REMARKS
I
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO 13E DONE
4) t_-ma 4 1 _cid ell� —
.
P
Plan Check
PROPOSED USE
BUILDING
PLUIU31NG
Q PLOT PLAN (Indicate Building netbackz� Eb—utting streets)
HEAT & GAS LINE
FENCE
t
SIGN
N
RETAINING WALL
SWIMWNG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby nek owledge 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-
ATTE1*MON
I&ting 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 PERMIT
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
AUTHORIZES
ONLY THEI
WORK NOTED
shall be completed in ninety days; MOVED_IjN BUILDINGS shall be oom-
pleted In six months.)
—71—D—ATESIGNED
INSPECTION
DEPARTMENT
SIONATUiM —(OWNER OR AGENT)
CITY OF
EDMONDS
NOTE: Applicant Siebject to Plan Check Fee
PR 6-1107
Thin Permit coven work to be done on private Property ONLY -
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate Permission-
I
[j YES [3 NO
Valuation I Fee
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-
lmowledged in space provided.
!F — 12 b
rum