680143.pdfN KROLL MAP NO.:
BUILDING DEPARTMENT Applicant Fill
Inside Heavy Lines
PERMIT APPLICATION
OF BUSINESS)
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rA-ft_,U0_=SE NUMBEA
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of Property f8how
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ElNEW
E-RESIDENTIAL
1 I
R
GAS
LINE
1:1
NON-REsrDENTL4.L
F�
sION
ADD
RErAIMNG
WALL
2__A,L7ER
DEMOLISH
EXCAVATE
n OR FILL
PENCE
( .......... x . ........ Ft.)
REPAIR
PRE -MOVE
13 INSP.
swim
POOL
FE-81
NITITBER OF
DWELLING
UNITS
EBB
7/62 5-
PERMIT
NUMBER
680143
REAR 7AIM SETBACK
TA—CANTSWE
W
YES E3 NO
NUMBE
VARIANCE R
Y�i_S!WNG'ST'REET R/W ....... .... FT. DEFICIENCY TIUS PROPERTY
COMP. PLAN ST. R/W ........... XT - — --- -- ET'
C] YES [3 NO
S-AW/ 4
Plan Check No .................
BUILDING
PLUMBING
PLOT PLAN (jn4Ij@t_eBuIIdIag setbacks, abutting streets)
HEAT & GAS LINE
PENCE
t
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 allthOr-
tzed agent of the ovvner. I &use to comply with city and state laws regu-
lating conBtmcUon; and in doing the work authorized thereby, no person
ATTENTION
will be employed In violation of the Labor Code of the State of Washington
ralaUng to Workmen's Compensation insurance.
NOTE: Permit Vimit One Year (Except DEATOMTIONS which
TIUS PERMIT
AUTHOMZES
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUXLDINGS shall be com-
pleted In mix months.)
INSPECTION
DEPARTMENT
CITY OF
a GNATU (OWNER OR AG3T)
LWA
E7 Je
EDMONDS
NOTTVAPPlicantlSubject to Plan Check Fee
m6-1107
- This Permit covers work to be done on private property ONJux-
Any constructlea on the pubtle domain (curbs, sidewalks, driveways,
manuecs, etc.) will require 90PArAte Permission. -
[] YES C] NO
Valuation I Fee I Receipt No.
OU
0 r_1
1,13
i6' !S3�
APPLICATION JkPPRC; VAL
This application Is.*aot a pem-dt until
signed by the Building official or his Dep-
uty; and fees are paid and receipt is ac-
lmowledged in space provided.
— 1 10 — Lo U
FILE a 4
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