680250.pdfILS,
JLDING DEPARTMENT
ERMIT APPLICATION
MOM POSTED ON KROLL MAP VO.: PERMIT
Applicant Fill NUMBER 680250
in -
inside Heavy Lines
JOB ADDRESS
SIDE YARD SETBACK I STRIGEW SETBACK REAR YARD SETBACK
or rroparty (Show Below Or AtLaM lot
617,
[3 YES 0 NO
EXISTING -STREET R/W ........... YT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... X-7. ............ IT.
ZONE
r1_7
RESIDENTIAL
'AS 0 YES 13 NO
CLINE PLAN BY
NEW
CHECKED
NON-RESIDENTIAL
SIGN
ADD
F1
RETAINING REMARKS
WALL
DEMOLISH
DALTER
1:1
EXCAVATE
OR FILL
PENCE
( x Ft.)
.......... ..........
REPAIR E]
PRE -MOVE
INSP.
SWIM
POOL
TUMBER OF STORIES
NUMBER OF
11 DWELLING
UNITS
�ATURE OF WORK TO BE DONE
/ A / ( //*
7-1^ /-, /- x 7 ,,;
te- C'
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby asknowledge that I have read this application; that the in-
formation 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
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 Till& PERMIT
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relating to Workmen's Compensation lasuranca. AUTHORIZES
ONLY TIM
NOTE: Permit Vimit One Year (Except DEMOLITIONS which WORK NOTED
core_
ED ba
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
UUNKT—URE (OWNER OR AGENT) LJAWN NIUNND INSPECTION
DEPARTMENT
CITY OF
MOM____ 8 MW EDMONDS
NOTE: Applicant Subject io'Plan Check Fee PR 6-1107
This Permit covers work to be done on private PrOPOrtY ONLY -
Any construction an the public domain (curbs, sidewalks, drivewaYs,
manuees, etc.) will require separate permission.
Valuation
[] YES [] NO
a
0
94
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Receipt 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.
0.
FILE
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