680094.pdfBUILDING DEPARTMENT
ApplicantFill
PERMIT APPLICATION
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NAME (OR NAME OF BUSINESS)
r3 e?.Pl /t/ L— -p— ;9 o D j
MA LING ADDRESS
LZ 6-:) e�— —A ZH— /V L�,)
CITY
-T T/,
PHONE NUMBER
VLE:Z �;.2 G C/L 7
NAME
7—c— fZ, 1, / Ar)D,.T & y
ADDRESS
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TELEPHONE NUMBER
NAME
13 0 P Y AVE CV 5 T IV C 0 X1
ADDRESS
6, JL� ,w A�,)
Z
CITY
-7— —j,-2-Z7-
TELEPHONE NUMBER
3 E'
STATE LICENSE NUMBER
CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
ej-7_Z-e1C/LF-,Q
GAS
M'N'EW nESIDENTLA LINE
NON-RESIDI TIAL R SIGN
RETAINING
DEMOLISH M WALL
DALTER EXCAVATE PENCE
F� OR FULL ( Ft.)
........ _x ..........
PRE -MOVE SWIM
REPAIR
F] INSP. POOL
j ES
NUMBER OF
DWELLING
UNITS Ilk
NATURE OF WORK TO BE DONE
T/1-7 C—
Z
PROPOSED USE
R cf— /V 7
PLOT PLAN (Indicate Building setbacks, abutting streets)
0
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I hereby acknowledge that I have read this application; that the in-
formation given to 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 Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Your (Except DEMOLITIONS which
shall be completed In ninety days: BIOVED-IN BUILDINGS shall be cum-
pleted In six months.)
SIGN T;U7/—( NE OR AGENT)
DATE SIGNED
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
DXISTING STREET R/W
COUP. PLAN ST. R/W
S 1% 1 13
YES [] NO
Plan Check No
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
Pn o-llm
PERMIT
NUMBER 680094
A
U,4�
IET BETBACIJ REAR YARD SETBACK
5-1 ov PI 0
AREA VAOAN-,V� SITE
WISS E3 NO
5ING AREA VARIANCE NUMBER ow
FT. DEFICIENCY THIS PROPERTY 0
cc,3�E Y 4
IQ
e,x
CL�EAIRL&ANC
CHE(1W BY
PROVED
A I [] YES [3 NO I I 1 11 1
Valuation Fee
APPLICATION APPROVAL
This application is not a pe
U�
signed by the Building Official T�i's De,'13-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
DIRE TOR'S 81 RE, JIF
DA?E i
FILE
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