680276.pdfBUILDINO UEFAKIMMI
ON Applicant FIII
PERMIT APPLICATI Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
a AJDDRY�S
CITY
NAME
ADDIMBB
'I A
TELEPHONE:
Below or
-3
GAS
RESIDENTIAL LINE
/0 NEW NON-RESIDENTIAL El SIGN
J
DRETAINING
DEMOLISH WALL
0 ALTER EXCAVATE PENCE
D OR FI"T ( .......... x .......... Ft.)
R13PAIR PRE -MOVE swim
M INSP. P OOL
N :S NUMBER OF
J DWELLING
.�2. 1 UNITS
q
-PROPOSED USE
------------
--PL--o_T__P_1VN —Undicate B-ui-ld-l-n-g-Be-t—ba-e-ko-,-F-Lbutting streets)
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N
I hereby acknowledge that I have read this application; that the in-
formation given to 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.
lating construction; and in doing the work authorized thereby, no person
will be employed III violation Of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Mmit One Year (Except DEMOLITIONS which
shall be Completed In ninety days; I%IOVED-IN BVILDINGS shall be com-
pleted In six months.)
SIGNATURE (OWNER OR A—GENT)l DATE, 13IGNED
L 7Z4�
NOTE: Applicant Snbiect to Plan Check Fee
iFida Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivewaYs,
marquees, etc.) will require separate permission.
C2 0 U)
=DRESS
3(p oq —
YARD SETBACK
ZONE
I I t -21- -
'77
J 2, 2�el,
EET SETBACK 1�� 77RD SETS.
) _(�- I M X5' I-n Z-
[3 NO
EXIS . TING , STREET R/W 6--(2..FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R1W.-5Q-XT- ... FT .
REMARKS
Driveway slopes not to exceed those
indicated on Standard Drawing 0103.
I CHECKED BY
, I a"��7
i(
[J YES [] NO
11,
or
0 YES [3 No
Dimensions of deck subject to Board of
Adjustment meeting on JulY 23, 1968,
Plan Check No ............
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
rn 6-1107
b
Fee
.9 (0 z-
Z
W
;9
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-
Imowledged In space provided.
DIRECTOR'S SIGNA
k&2'
D
FILE
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