680282.pdfr
C
BuIlDING DIPARTMINT
PERMIT APPLICATION
AppUcmt FM
Inside HeAVYLUeS
�OBTED ON KROLL MAP NO-:
PERMIT
I MDEBER 680282
JOB ADDRESS
/ P7 r?
au
X_�_ Is 10
SIDE YARD 811717BACK
STREET SETBACK
HEAR YARD SETIL
MAILING ADDRMB 17F Cot*
a 01, 6
USE ZONE
LOTAREA
VACANT BITE
[3 YES 0 NO
CITY
LmLabrAlurim NUMBER
ft
—fie F— tql�l
HEIGHT
BUILDING ARICA
VARIANCE NUMBS
PLOT PLAN APPROVE
ABDIU�
CITY TELEPHONE NUMBW—
ffrm= R/W
EXISTING STREET R/W DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ........ ... FT. .......... PT.
REMARKS
ADDRESS
BY
8
CITY
TELEPHONE NUMBER
METER SIZE
SERVICE SIZE
CLEARANCE
CHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUM—BER
REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
TYPE CONNECTION
1
VERIFIED BY
X"� 06
uwnn MERT
I Pr.Tt?XTP NTrMVtr.R
NEW
RESMENTLALL
GAS
LINE
NON-RESMENTIAL
SIGN
RETAnqING
DEMOLISH
WALL
EIALTER
EXCAVATE
PENCE
OR FILL
( x Ft.)
REPAIR
PRE -MOVE
INSP.
.......... . .......
SWIM
POOL
FUMBER OF 3TORLES
NU303M OF
DWELLING
UNITS
[] YES 13 NO
Plan Check
PROPOSED USE
BUILDING
PLOT PLAN (ItidicatO Building setbacks, Zutting st�reeisj
PLUN33ING
BEAT & GAS LINE
FENCE
t
SIGN
RETArNING WALL
SWIMMING POOL
DEMOLITION
PRE MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; Mat 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
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 Workman's Compensation Insurance.
AUTHORTZ
NOTE: Permit Umit One Year (Except DEMOLITIONS which
ONLY T13E
WORK N07ZD
shoal be completed in ninety day#; MOVK]DALN BUILDINGS shLII be corn.
pleted In six months.)
SIGNATURE (OWNER �?AGENT) DATE SIGNED
INSP ECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit coven work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
m, wees, etc.) will require separate permission.
Valuation
O.Z_
13 YES [3 NO
Fee
M
APPLICATION APPROVAL
This application Is not a Perinit until
signed by the Building official or his Dep�
uty; and fees are paid, and receipt is ac-
knowledged in space provided.