680171.pdf4�
POSTED ON KROLL M" NO.:
PERMIT 680171
'#I`,',L'DING DEPARTMENT
Applicant F111
NUMBER
OUT APPLICATION
Inside Heavy Lines
JOB ADDRESS
L
BUSINESS)
(OR NAMM OF
VBACK STREET SETBACK REAR YARD SE;F13ACK
E ��RD 8 1 1
-7 i-n rp
c;!s-
-VA—CANT
ONE 11UN AREA
SITE
Tif,"FALONE allMBER
T T q
0 YES 0
xul
A
WA S t,-
4-901
HEIGHT VARIANCE
$6
okids
AV010
PLOT PLA PR VED
SIT
I, II13TI G 13TREET R/W ......... X-r-
U13TI G I
DEFICIENCY THIS PROPERTY
TELEPHONE NUMBER
TV.
COMP. PLAN ST. R/W ........... XT . .
. ............
0
REMARKS
C
or
RESIDENTIAL
GAS
LINE
19 NEW
NON-RESIDENTLILL
SIGN
171 ADD
RETAINING
F-1
DEMOLISH
WALL
E] ALTER
n
EXCt.VJLTE
on rim
PENCE
( x Fit.)
.......... .. .......
El REPAIR
n
PRE -MOVE
INSP.
swim
POOL
11UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
C] YES [] NO
or
Plan Check No ..................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
BEAT & GAS LINE
PENCE
t
SIGN
N
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-
ATTENTION
laung construction; and In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the Stato of Washington
THIS PERMIT
relating to WorlmaeWs Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shoal be completed In ninety days; MOVED -IN BUILDINGS shall be com-
plated In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
J5101 0
CITY OF
Im
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit covers work to be dam anprivate Property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate pern188100.
I
ra
[] YES 13 NO
Valuation I Fee I Receipt No.
M
I 10, on 1(437P
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-
lmowledged in space provided.
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