680220.pdf... .... . ...
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1 MAILING ADDRESB
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RESIDENTIAL
GAS
LINE
ElADD
NON-RESIDENTIAI.
SIGN
RETAINING
DDEMOLISH
WALL
E]
EXCAVATE
PENCE
ALTER
n
OR FILL
Ft.)
REPAIR
E3
PRE -MOVE
INSP.
.. .......
swim
POOL
[UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
'I KROLL MAP NU.: PER IT
NUMB ER
DSS
D SETBAC!E I
'�Y M ;J
STREET I SETBAVK
2S M LAJ
VACANT 8179a
E3 YEB 0 NO
VARIANCE NUMBER I IL�
EXISTING'STREET R/W ........... FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... XT. .......... FT .
13 YES
Follius
G14"d
Plan Check No ..................
PROPOSED USE
BUILDING
PLOT PLAN (indicate Bundin fietbacits, abutting
eta)
PLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
N
RETAINING WALL
swim No POOL
DEMOLITION
)qi
PRE -MOVE INSPECTION
EXCAVATION OR FILL
g%o,7
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thLl application; that the in-
formation given Is correct; and that I am the owner, or the duly author-
ized agent of the owner. I ngres to comply with city and state lawn 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
THIS PERMIT
relaung to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Umit One Your (Except DEMOXJTXON8 which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six mon,08.)
11_GNATUI�(NE OR A
DATE IGNED.
INSPECTION
_,QENT)
_I
DEPARTMENT
F
C
CITY OF
EDMONDS
NOTE: Applicant Subject to Plats Check Fee
PR 0-1107
This Permit coven work to be done an priveAe property ONLY.
Any cokstructlon on the public donusin (curbs# eldawalliBs drivowaysp
mexquees, etc.) Will require separate pern-dislon.
[] YES E] NO
Valuation
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.
-;)- I - 6"1
PIT