680322.pdfPOSTED ON KR
BUILDING DEPARTMENT Appllemt FIH / X 0
PERMIT APPLICATION Inside Heavy Lines jOB ADDRESS
NAM (OR NAME OF BUSINESS) /70
AA L/ ID kL� ZL 1"I (Z SIDE YARD 8
Q
AILING ADDRESS 4�
12-2/fa
ITY TELEPHONE NUMBi
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or
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NEW
RESIDENTIAL
El
GAR
LINE
NON-RESIDENTIAL
r I
SIGN
ADD
RETAINING
DEMOLISH
WALL
DALTER
0
EXCAVATE
OR FILL
PENCE
( x Ft.)
........ . ..........
REPAIR
PRE -MOVE
INSP.
swim
POOL
:S
NUMBER OF
DWELLING
UNITS
4ATURE OF WORK TO BE DONE
C ON S7-QVr- 7- 'N)Fkl
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� Lit
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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-
lzed agent of the owner. I agree to comply with city and state lawn regu.
lating construction; and In doing the work authorized thereby, no penvon
will be employed In violation of the Labor Code of the State of Washington
relating to WorkmWe Compensation Insurance.
NOTE: Permit Limit One Your (Except DEMOLITIONS which
shall be completed In ninety days; AIOVED.XN DUELMINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquess, etc.) will require separate permission.
I
OLL MAP NO.:
PERMIT
NUMBER
CK
a TREET SETBACK
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is -) / , ),
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f &J
q&24ARD 8 TBACK
a
VACANT BITE
13 Yns [3 NO
VARIANCE NUM
EXISTING STREET R/W ........... J�T- DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. ........... P'T.
i (
Q
<A,UA—�A,_
TYPE
I [] YES I -TO
Q9_ —INSPLOTOR RE—QUIVIR—E—D OCCUPANCY GROUP
0 YES 0 NO I I
Plan Check No .....................
BUrLDING
PLUMBING
BEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
13WIMNUNG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTUNMON
THIS PERbUT
AUTnOIUZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
r
Fee
45 (3
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-
knowledged in space provided.
FILE
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