680201.pdfPOSTED ON KROLL MAP N,
BUILDING DEPARTMENT Applicant FIII
PERMIT APPLICATION Inside Heavy Lines jOB ADDRESS
NAMM (OR NAME OF BUSINESS)
/2 - / f �_4 f I I .,DE ARD SETBACK STI
7q 4�p(' a'/
or
r
F1NEW
RESIDENTIAL
I
GAS
LINE
E]
NON-RESIDENTIAL
SIGN
0—D
RETAINING
DEMOLISH
WALL
EXCAVJkTE
FENCE
ALTER
OR FILL
( X Ft.)
REPAIR
PRE -MOVE
INSP.
........ . ..........
SWIM
POOL
IUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
Vol
PERMIT
NUMBER 680201
Y
SETBACK REAR YARD SETBACK
I �� , A-r-�, 0
/6-, 127 , I
A VACANT SITE
0 YEB [3 NO
AREA I VARIANCE NUMBER
WaSTING STREET R/W ....... .... FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W .......... XT. ....... .... F.T.
13 YES [3 NO
REMAIM-8
Z
0
Plan Check No ................ ...
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting Streets)
PLUMBING
02
HEAT & GAS LINE
FENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
OLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given to 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
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
TIU13 PERMIT
relaUng to Workman's Compensation Insurance.
AUTHORIZES
NOTE: Permit Umit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -]IN BUILDINGS $hall be com-
Pleted in six months.)
SIGNATURE (OWNER OR AGENT) D TN SIGNED
INSPECTION
DEPARTMENT
vi� 1&4 6'
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1101
This Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, ato.) will require separate permission.
Valuation
[] YES 13 NO
3
0
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-
knowledged in space provided.
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A
FILE
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