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N1=—F0—ErrEDoN
KROLL MAP NO.:
PERMIT
BUILDING DEPARTMENT Applicant FIR
NUMBER
PERMIT APPLICATION Inside Heavy Lines
JOB ADDRESS
NAMM (OR NAME - OF BUSI�ESS)
. . . I
/Vl....
MATT, NG ADDREH
SIDE Y D SETBACK
I A I
STREET 8 f ETBACK
I g n I
USE ZqZqE LOT AREA
TELEPHONE NUMBER
U-)
HEIGHT
BUILD
Z
8
Z
C. ha 14- e? t 0T_,_)'C.
Vaa�ltrorSecl,19. X�a,-wAip 6-7&' Rrtn�e
11)A4 - -,q, Al ,-?(7 ��A. .1)
I
RESIDENTIA
GAS
LINE
NEW
[Ali
R
I -ION -RESIDE TIAL
SIGN
EJ
RETAII-TING
WALL
DEMOLISH
ALTER
EXCAVATE
OR FILL
FENCE
( ........ . x .......... Ft.)
REPAIR
PRE MOVE
INS;.
SWIM
POOL
rUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
9, �5/-
REAR YARD SETBACK
VACANT SITE
C3 YES OCHO
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ....... . .... 11 T. 0
REMARKS 14
0 YES 0 NO
or
Plan Check No ..................
PROPOSED USE)
BUILDING
PLOT PLAN (Indic ullding setbacks, abutting streets)
PLUMBING
Z N�
HEAT & GAS IMiB
PENCE
SIGN
N
RETAINING WALL
SWIMMING POOL
OLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
041
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 -
lead agent of the owner. I agree to comply with city and state laws regu-
AT=NMON
lating construction; and In doing the work authorized thereby, no person
will be employed in violation of the Labor Coda of the State of Washington
THIS PER511T
relating to Workmen's Compensation Insurance.
AuTnonlizEs
ONLY THE
NOTE: Permit Vimit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed In ninety days; MOVEDALN BUILDINGS shall be oom-
plated in mix months.)
32�TURE (OW14NR un SIGNED
INSPECTION
kDATE
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
Pit 6.1107
iiis —Permit covers work to be done on private property ONLY -
Any eongtrilCtlm an the pnblic domain (curbs, sidewalks, driveways,
mamueest etc,) will require separate permission.
[] YES 0 NO
Valuation I Fee
0'�_ 1 .3
Zo
I
M
RO
APPLICATION APPROVAL
This application is not a perralt until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
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Y�j
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Fir'e
Dept..