680109.pdfPOBTED ON KROLL MAP NO.: PERMIT
680109
BUILDING DEPARTMENT
Cant Fill
Applicant M
NUMBER
PERMIT APPLICATION
Inside Heavy Lines
eaVy Lines
JOB ADDREUS
NAME NAME OF BUSINEV)
Y
F_(OR
A-,'127
4
INUMB
SIDE YARD SETBACK
e
STREET SET13ACK
REAR YARD SETEX
I
WA MING ADDRESS
44e
/,9
I
/77.0.j
1117 Aow 17,,�
LOT AREA
VACANT SITE
I'ry
CITY
WAI
TELEPHONE
Ji
HEIGHT
13UILDING AREA
[3 NO
TIMBER
Z
I '� / .20_r7o
STATE LICENSE NUMBER CITY LICENSE NUMj
Za 5 __ 110 / — Y 7..7— r ' I
Z
2
B/NEW
RESIDENTIAL
AS
12�LINE
ADD
EDNON-RESIDENTIAL
SIGN
RETAINING
DEMOLISH
WALL
ALTER
EXCAVATE
OR FILL
FENCE
I x Ft.)
REPAIR
PRE -MOVE
INSP.
El
........ . ..........
swim
POOL
TUMBER OF STORIES
NUMBER or
DWELLING
UNITS
nksmow "/IV e
EXISTING STREET R/W DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W 4k7..._P`T. ..... q.YT.
[] YES
1( 1 -3/4 cc
Plan Check No .....................
PROPOSED USE
BUILDING
PLOT PLAN (Indicattf ndfldlng s acka, atmEting streets)
e)p
PLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
.2/
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby fteknowledi;o that I have read this application; Chat 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 rogu-
ATTENMION
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
THIS PEPIUT
relating to Workmen's Compensation Insurance.
AUTHORLL "S
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; AIOVED-IN BUILDINGS shall be Dom-
pleted In BLZ months.)
UGNATURE (OWNER OR AGV47r)
2:��4-�
DATE GNED
5
INSP ECTION
DEPARTMENT
000
CITY OF
rmm� —
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit covm work to be done, an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, ate.) will require separate permission.
Valuation
13 YES [3 NO
4 (0_�
I
to
No.
I Cf /. vp A9 I V+5 14
APPLICATION APPROVAL
Thic application is not a permit until
signed by the Building Official or his Dep-
uty; and f ees are paid, and receipt Is ac-
Icnowledged in space provided.
I