680311.pdf. .. .......
POSTED ON KROLL MAP NO.: PER IT
IJUILDING WARTMINT Applicant Fill
NUM13ER
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PERMIT APPLICI Inside Heavy Lines
jOB ADDRESS
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N (OR NAME OF BUSI 131-531
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1
7
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SIDE YARD SETBACK
STREET SETBACK
—MAILING ADDRESS
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0/ / 4
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USE ZONE
1
LOT AREA
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CITY I wh;"PkioNE1 NUMBER
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BUILDING AREA
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Legal Description of Props 3�" how Below or Al
6
NEW
RESIDENTIAL
GAS
LINE
E,
El
NON-RESIDENTXAL
F71
ADD
SIGN
UN
F1DEMOLISH
F1
RETAINING
WALL
EXCAVATE
PENCE
ALTER
M OR FILL
Ft.)
( ........ . x ..........
REPAIR
E] PRE -MOVE
INSP.
SWIM
POOL
FUMBER OF STORIES
NUMBER 7U.P
DWELLING
UNITS
LAXURE OF WORK TO BE DONE
A- -7/ 0 (/"10C)p r
680311
AR YARD SETBACK
,CANT SITE
YES )<NO
i�cm 14
UMBER I a,
EN38TING STREET R/W ........ .. XIT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ rr. .......... IT.
TYPE OF
E] YES [3 NO
Plan Check No ............. ... ...
PROPOSED USE BUILDING
PLOT PLAN (Indicate Building setbacks. abutting streets) PLUMBING
92
HEAT & GAS LINE
PENCE
t SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge Mat I have read this application; that the in-
formation given In 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 Me Labor Code of the State of Washington THIS PERAUT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY TIEE:
NOTE: Permit Umit Ono Year (Except DE51011TIONS which WORK NOTED
shall be completed in ninety days: MOVED -IN BUILDINGS shall be com-
pleted In six months.)
SIONAT,t#tE (OWNER_J�# AGE DATE SIGNED INSPECTION
DEPARTMENT
7� 7-Atz- 6 CITY Op
�Mm� EDMONDS
NOTE: Applicant Subject to Plan Cbeck Fee FR 6-1107
This Permit covers work to be done onprivate property ONLY.
A,ny ounstraction on the public domain (curb*, sidewalks. drivoways.
com,quees, otc.) will require, separate pern-dsolon.
[3 YES [3 NO
Fee
1 3.61-0
a
14
No.
APPLICATION APPROVAL
This application is not a pernift until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
14-
W,