680158.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Hesivy Lines
NAM (OR NAME OF BUSINESS)
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POSTED ON KROLL ILAP NO.:
PERMIT
680158
/ A 0
NUMBER..
JOB ADDRESS
I /93tq-
SIDE YARD SETBACK
BTainwr OETBACK
RNAlf, xp�u BETBACK
o
USE -ZONE
LOT AAEA
VACANT BIT19
YES C3 NO
I nTTTT.nTWtZ AREA
I VARIANCE NUM PIK AW
ETNEW
RESIDENTIAL
El
GAS
LINE
NON -REBID ENTIAL
SIGN
RETAINING
FiWALL
DEMOLISH
ALTER
EXCAVATE
OR FILL
El
PENCE
( x Ft.)
........ . ..........
REPAIR
PRE -MOVE
INSP.
swim
POOL
ES
NUMBEK OF
DWELLING
UNITS
[] YES
/I
41
'W
STREET
l,AN ST.
put
or
Plan Check No ............ ........
PROPOSED USE
BUILDING
33 it I
-FL—OT PLAN (IndicateJ48 ng setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
RETAINING WALL
A�
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
the In-
TOTAL AMOUNT DUE
I hereby ackuKA60il'that 1 hitye read this application; that
formation given in correct; and that I am the owner, or the duly author-
tzed agent of the owner. I agree to comply with city and state laws regu-
ATTENT)ION
lating construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the StSta of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in at% months.)
31ONATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
CL
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR (1-1107
This Permit cov� work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, ate.) will require sepamte permission.
DEFICIENCY THIS PROPERTY
0 YES 0 No
Valuation I Fee I Receipt No.
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
I