680312.pdfA
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POSTED ON KROLL MAP NO.:
PERMIT b8UJ12
BUILDING
DEPARTMENT
Applicant Fill
71
NUMBER
I
PERMIT
APPLICATION
Inside Heavy Lines
JOB ADDRESS
t7
�efi
NAME (OR NAM OF BUSINESS)
k..,2
[—CITX
SIDE! YARD SETBACK
r70
STREET HETBACX ItEA.It. YARD EETB___
NG ADDIIESS
MAJ.
�07q_
RSq
—rTELEPHONIG 14UM13ER
LOT AREA
VACANX SITE
0 YES N
0 YES ;5co
NAM
j I 9."W�
or
VFMA
IE
NEW
RESIDENTIAL
NON-RESIDENTIAL
El
GAS
LINE
SIGN
[�JIADD
ALTER
REPAIR
0
D
DEMOLISH
MCCAVATE
OR FULL
PRE -MOVE
INSP.
El
RETAINING
WALL
FENCE
( .......... x .......... Ft.)
swim
POOL
NUMBElt OF
DWELLING
UNITS
HEIGHT BUILDING AREA VARIA
ENaSTING - STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... XT. ........ ... FT,
E] YES -'ea N 0
Plan Check No ............
BUILDING
PLUMBING Qbj,�C�
HEAT & GAS LINE
PENCE
t
SIGN
N
RETAINING WALL
SWIM NG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that 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-
ATMNTION
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 Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEIHOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS ahall be corn-
pleted in mix months.)
RE (OWNER OR AGEN DATE SIGNED
INSPECTION
DEPARTMENT
,�7
CITY OF
EDMONDS
NOTE: Applicant Subject to Plait Check Fee
PR 6-1101
This Permit covers work to be done an private property ONLY.
Any construction an the public donuL]n (curbs. sidewalks, driveways,
marquees, etc.) will require separate perridsBion.
e—
0 YES [3 No
Fee
- vn1- I I r;. o 0
APPLICATION APPROVAL
Z
N
No.
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.
V — P 0
rum
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