680119.pdf_r . .... ...... . .....
POSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT NUMBER 680119
ApplicantFill
PERMIT APPLICAT101i Inside Heavy Lines JOB ADDRESS
VAM (Oft NAME OF BUSINESS)
3 V r7 <1
SETBACI STREET SETBACK REAB,YARD SET
BIDE YARD BACK
0�,
G ADDRESS I - I I
/ 0 -2 _(�
S:FkZ— USE ZONE LOT AREA VACANT SITE
CITY TELEPHONE NUMBER [3 YES VNO
HEIGHT BUILDING AREA VARIANC�/IUMBER 14
NAME
PLOT PLAN APPROVED
ADDRESS
STREET R/W
CITY TELEPHONE NUMBER EXISTING STREET R/W ........... J FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... XT.
REMARKS
NAME
1,0 Po
0
z
CRECKEI) BY
CITY TELEPHONE NUMBER
z
METER SIZE SERVICE SIZE I CLEARANCE ICRECKED By
STATE LICENSE NUMBER CITY LICENSE NUMBER
REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
—101 'i
NEW
WRESIDENTU
0
GAS
LINE
1 1:1
NON -RESIDE TIAL
F_1
SIGN
F] .
r_1
DEMOLISH
RETAINING
WALL
EXCAVATE
FENCE
ALTER
0
OR FILL
( x Ft.)
E] REPAIR
E3
PRE -MOVE
INSP.
........ . ..........
swim
POOL
NUMBER OF
DWELLING
UNITS
FIRE ZONE
[] YES
[] NO
z
Plan Check No ............ . .......
PROPOSED UBE
BUILDING
PLOT PLAN (Indicate Building setbacks. abUtting streets)
PLUMBING
HEAT & GAS LINE
FENCE
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 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 ATTENTION
will be employed in violation of the Labor Code of the State of Washington THIS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit Ono Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
;q TUBE (OWNER 011__A.GENTJ DATIq SIGN7D INSPECTION
9l, PARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plats Cbeck Fee PR 6-1107
This rerundt covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drlvuvvays,
marquees, ate.) will require separate permission.
I
to
13 YES 13 NO
Fee I Receipt No.
0 - 3
APPLICATION APPROVAL
This application is not a permit until
isigned by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
n