680253.pdft
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POSTED ON KROLL
BUILDING DEPARTMENT Applicant FM
PERMITAPPLICATION Inside Heavy Lines JOB ADDRESS
NAME (OR NAME OF BUSINESS) 7qc;�_ / —
SIDE YARD SETHA
MAILING ADDRESS
USE ZONE
- - -- --------- ....
or
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NEW
RESIDENTIAL
I
GAS
LINE
1:1
NON-RESIDENTIAL
r I
SIGN
ADD
nDEMOLISH
RETAINING
WALL
EXCAVATE
FENCE
ALTER
n
OR FULL
( x Ft.)
E] REPAIR
Ej
PRE -MOVE
INSP.
......... .........
swim
POOL
FUMBER OF STORIES
I NUMBER W,
DWELLING
UNITS
P NO.: PERMIT
I NUMBER 680253
— 1b. W.
SETBACK BEAR Y,
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[3 YES
RETBACK
0
NO Z
13
7U-M-Rna M I I
EXISTING STREET R/W ............ Fr. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT.
0 YES [] NO
Z
Plan Check No ....................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building Setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this 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
latitig 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
NOTE: Permit Umit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
Pleted In six months.)
SIGNATURE (OWNER OR AGENT)
DATE 8 GNED
INSPECTION
I
DEPARTMENT
a�m
P
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
13 YES [3 I -TO
Valuation I Fee
Z
W
No.
1 '5) - 0 a [q �%�
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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Fire Dept.