680213.pdfI
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BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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P NO.:
PERMIT
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I NUMBER 680213
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SIDE YARD SETBACK
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U13E ZONE
STREET SETBACK
I
LOT AREA
REAR YARD SETBACK
VACANT SITE
A77.5—, 1,-2,1
1 mllf�s 13 NO
HEIGHT
I BUILDING AREA
I VARIANCE NUWB—ER
NEW
RESIDENTIAL
GAS
LINE
LEI
NON-RESIDENTIAL
SIGN
ADD
=ERETAINING
WALL
MOLISH
EXCAVATE
FENCE
ALTER
OR IPILL
. ........ Ft.)
REPAIR
PRE -MOVE
SWIM
INSP.
POOL
NUMBER OF
DWELLING
UNITS
I
FATURE I OF WORK TOt4FPONE 11
EXISTING STREET R/W .... ....... FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ Fr. —0
REMARKS 1A
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tv&i
TPE CON E
TION
VERIF]I���
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ERIC. TE
PERMIT Nlr4BER
MMARKS
[3 YES
Plan Check No ...................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
3+!
10, N
10,
RETAINING WALL
11,3"
SWIMMING POOL
DEMOLITION
PRE INSPECTION
-MOVE
Fr
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read Me 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
latIng construction; and irk doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
THIS PERMIT
relaung to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days MOVEDAN BUILDINGS shall be com.
elp�le In pix months.)
81 N A )ATEAIGNFJ1
INS PECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Checf Fee
'
PIt 6-1107
This Permit cOvCrS work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
YES
Valuation I Fee I Receipt No.
0
ro
1073
APPLICATION APPROVAL
This application is not & perinit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged In space provided.
D ORIS HIQW�
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