680261.pdf011
POSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant Fill I NUMBER 680261
PERMIT APPLICATION Inside Heavy Lines JOB ADDREB13 V
NAME (OR NAME OF 15UHINE88) t q 'D -A- — 'Z -D, FL -.a- te,
SIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK
Ef & /V C' Y.V.\ . I S_ I ?
MAILING ADDRESS A^Aj :)--5 ry'\ A---%.j ry) 4, 0
1 q 70;2 USE ZONE LOT AREA VACANT SITE
Aar- /1)czs/
CITY rELEPHONE-NUMBEW YES 'KN 0 Z
HEIGHT BUiL—DINGAREA VARIANCE/lUMMUn at
ADDRESS
STREET R/W
EX38TING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... XT. .......... 17. —0
CITY
B ER
TELEPHONE NUMBER
REMARKS
NAME
Ale L
Z
ADDRESS
CHECKED BY
CITY
B
TELEPHONE NUM13MR
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
Cd
I
STATE LICENSE NUMBER
NUMBER
REMARKS
;:�
Legal Description of Property (Show,Below or At1A7M5* pt,
em. WIMI)OI PERC. TEST PERMIT NUMBER
REMARKS
E] NEW
P-14 '
IL.r RESIDENTIA
�NTIAL
0
GAS
LINE
NON-RESIDI
El
SIGN
RETAINING
El
WALL
DEMOLISH
EXCAVATE
PENCE
ALTER
0
OR FILL
( X Ft.)
REPAIR
PRE -MOVE
INSP.
.......... ..........
swim
POOL
:ES
NUMBER OF
DWELLING
UNITS
0 YES C] NO
Plan Check No ............ . .......
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
k
T
RETAINING WALL
SWIMMING POOL
Q
DEMOLITION
PRE-MOVn INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin 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 lawn regu-
AT= NTION
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
relating to Workmen'S Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be crmpleted In ninety days; MOVED -IN BUILDINGS shall be com-
pleted Jr. mix months,)
-0—GNATU-10
_(OWNER-UR AGENT) SIGNED
INSPECTION
7ATE
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-1101
This remit covers work to be done on private property ONLY.
Any construction an the public domain (curbs. sidewalks, driveways,
maNuces, etc.) will require separate permission.
[] YES 13 NO
Fee
i z. v n r44,1 i
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.
b -�6
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