680204.pdfI
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P41
BUILDING DEPARTMENT
PERMIT APPLICATIO14
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0� WL4"
Applicant Fill
Insido Heavy Lines
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46 )c —
, / - 6 �- I— C.-
0�-VEOSIDENTIAL
GAS
LINE
ADD
1:1
NON-RESIDENTIAL
SIGN
RETAINING
nDEMOLISH
WALL
EXCAVATE
FENCE
ALTER
OR FILL
( x Ft.)
REPAIR
PRE -MOVE
INSP.
........ . ..........
swim
POOL
NUMBER OF
DWELLING
UNITS
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KROLL MAP NO.:
4;�_ 0 W
is
.38 6- 91
SETBACK STREET BE
251
LOT AREA,
PERMIT
NUMBER 680204
e M rikel— 6c�izc
IACK REAR YARD SETBJ
VACANT 131WE
trfgs [3 NO
EXISTING STREET R/W . ......... FT. DEFICIENCY
COMP. PLAN ST. RfW A.0 .. =. ... <
indicat-ed on -Standard Drawing #103.
El YES
U
TYPE
Plan Check No ...................
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets) PLUMBING
HEAT& GAS LINE
PENCE
ION
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
Z> EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formaUon given in 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
tating construction; and in doing the work authorized thereby, no person
will be employed In violation Of the Labor Code of the State 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 six months.)
INSPECTION
jI.pjATURE (OWNER 0 AGENT) DATE 81GNED
DEPARTMENT
J CITY OF
I EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This Pern-dt coven work to be done on private property ONLY.
Any construction On the public donuLln, (curb$, sidewalks, driveways,
warqueesl etcj will require separate permission.
PROPERTY
0— ^,�, I [] YES [3 No
Valuation
Fee
Fe 6-6
6L ON
No.
1// 9 - " I 4ec//3
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.
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FILE
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