680268.pdfPOSTED
ON KROI�L MAP NO-: PERMIT
NUMBER
680268
ILDING
DEPARTMENT
Applicant
PERMIT APPLICATIO N
Inside Heavy es
JOB
ADDRESS
NJ�7 NAME
OF BUSINESS)
SIDE
YARD SETBACK
STREET SETBACK
REAR YAR D SETBACK
30? 0
C-ti /j
TELEPHONE NUMBER
puon or A-roperty (Show Below or Attach Four Copies)
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OF k/40-
5'
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NEW
RESIDENTIAL
n
GAS
LINE
�"u
NON-RESIDENTLAL
F]
SIGN
RETAINING
DEMOLISH
WALL
ALTER
EXCAVATE
OR FILL
NO
....... .. .... rt.)
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
I NUMBER OF
DWELLING
UNITS
I hereby acknowledge that I have read this application; that the In-
formation given In correct; and that I am the ci or the duly author-
ized agent of the owner. I agree to comply with city and state law$ regu-
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
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DE5101ATIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be oom-
pleted In six monthfi.)
NOTE: Applicant Subject to Plan Check Fee
VACANT SITE
YES [3 NO
VA &NOE NUMBER
' op- '.
711i�
STRE
EXISTING STREET R/W ............ FT. DEFICIENCY TWS PROPERTY
COUP. PLAN ST. R/W ............ FT. ............ FT.
Z
N
C3 YES [3 NO
Ij YES [3 NO
rian check No ............ . .......
Valuation
Fee
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
C"C2
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
TIHS PERMT
This application Is not a permit until
AUTHORIZES
Signed by the Building Official or his Dep-
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
INSPECTION
_DIRECTO] 'S Q NAT
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
This PW;lt -comwork to be done On private property ONLY.
Sys, FILE
Any construction on the public domain (curb#, sidewalks, drivew
marquees, Ore.) will require separate permission.
I