680298.pdfLevi 4� 9
BUILDING DEPARTMINT POSTED ON KROLL MAP NO.: PERMIT
Applicant Fill NUMBER
PERMITAPPLICATION Inside Heavy Lines JOB ADDRESS
NA*M R rE,0F BUSINE e?.,2 _�L_ 'A
"Cant FMes IDE YARD SETBAC TREET SETBACK FEAR
CaVy L
MAILING ADDRESS
C7,_v r_:� 4o - USE ZONE LOT ARIGA VACAZ
0 14 =jHT-
011 z I TELEPHONE NUMBER 0 YI:s
M0/t/ P S -g; HEIGHT 13ULLADING AREA VARLA
PL40T PLAN APPROVED
Legal Description Of Property (Show Below or Attacu Four uopies)
Portion of lot 53 Edmonds Sea View
z �ractsq beg at nw cor tract 53 th se ali
a3ine tract 53 for 1001, th s to point 1
s line tract 53 which is 1901 a e from
W cor th " to R W cnr AA4 a t�rftct 53
n along w line to point of beginning,
z
RESIDENTIAL
F1
GAS
LINE
NEW
i
11
rl
NON-RESIDENTLILL
D
SIGN
ADD
RETAINING
DDEMOLISH
El
WALL
ALTER
D
EXCAVATE
OR FILL
FI
PENVE
x1Tx_.k..Ft.)
D
REPAIR
M
PRE -MOVE
INSP.
SWIM
POOL
ES
NUMBER OF
DWELLING
UNITS
80298
f P BACK
ICE JRUMBER JV6
EXISTING STREET R/W ............ FT. DEricimcy THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. ............ IrT.
[] YES [3 NO
Plan Check No ............. . .....
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building notbacks, abutting streets) PLUMBING
HEAT & GAS LINE
PENCE
t SIGN
RETAINING WALL
SWIMMING POOL
OLITION
PRE -MOVE INSPECTION
EXCAVATION OR PILL
TOTAL AMOUNT DUE
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-
lzed ngent of the owner. I agree to comply with city and state lawn 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
relaUng to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall omp ted ninety days; MOVED -IN BUILDINGS shall be eom-
ple ed In six m a. /-I
awmRE :(E 1GNED INSPECTION
U T) DATE SlUNEI DEPARTMENT
CITY OF
LIM, EDMONDS
NOTE: Appficanf�'Subject to Plan Check Fee PH 6-1107
This Peradt covers work to be done onprivate property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
0.9-
17
41
[] YES El NO
I 11. 0 -0 1 q-s-I I
APPLICATION APPROVAL
This application is not a pern-ilt until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
I
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