680069.pdfA
__ P TED ON KROLL MAP NO.:
a
PERMIT
BUILDING
DEPARTMENT
Applicant Fill 4V
NUMBER
A
9-T
DCDUIT
ADDIWATI
M
I Inside Heavy Linesi JOB ADDRESS
1,06
NAM (Oft NAME OF BUSINESS)
MAILING ADDRESS
ql,g_ _
CITY -F—TELEE
�C41_177,1,17
'Soln e__-
.2'a.3 - 0 / -
or
BID A D SETBACK
BW)t F.T SETBACK
REAR YARD SETBACK
BE Z
LOT AREA
VACANT SITE
eYES [3 NO Z
n
_9U M —BE R W
EXISTING STREET n/W ........ ... FT.
COUP. PLAN ST. R/Wl:i. XT.
2"N�
— I RESIDENTIAL
LINE
N r
EW
NON-RESIDENTIAL
SIGN
El�v
RETAINING
WALL
DEMOLISH
ALTER
EXCAVATE
OR FILL
FENCE
( ........ . x .......... 71.)
I
REPAIR
PRE -MOVE
INSP.
swim
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
IPROPOSED USE
Q 'k9'0_S
necate Building setbac 1, butting at to)
-FL-0TpLAN_ (J 1�
4
t
N
I
I hereby acknowledge that I have read thin application; that the In-
formation 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-
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Coda of the State of Washington
relating to WorkmeWN Compensation Insurance -
NOTE: Permit Umit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVFAD-IN BUILDINGS shall be com-
pleted in six months.)
!1_6_NAT(6wNFR OR AGENT) DATE 81 N D
NOTE: Applicant Subject to Plan Check Fee %
-ims Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
manueom, etc.) %vill requira separate permission.
0
[] YES [J NO
Plan Check No ............
Q
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
DEFICIENCY THIS PROPERTY
00
IWKED BY
IER
STREET IMPROVED
[J YES
Fee
I
TOTAL AMOUNT DUE
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
I knowledged in Space provided.
INSPECTION DIUEQTQR'S SIG�r��
DEPARTMENT
CITY OF
EDMONDS DATE
PIL 6-1107
. % � . . - ---------- � � .1
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