680356.pdf"#ft' ING DEPARTMENT
.1T.APPLICATION
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/501
W_AV2r4_W
Applicant EM
Inside Heavy Lines
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9kc/TELEPHONE NUMBFU
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NEW
RESIDENTIAL
GAS
LINE
ADD
NON-RESIDENTIAL
SIGN
RETAINING
DEMOLISH
WALL
ALTER
EXCAVATE
OR FILL
PENCE
( x Ft.)
E]
REPAIR
PRE -MOVE
INSP.
........ . ..........
swim
POOL
NUMBER OF
DWELLING
UNITS
W
6 Lf�
D BL"1_
0
PERMIT
NUMBER
el- j2
680356
.a 5 1
NO
. .. sT/ TV
EXISTING STREET R/W DEFICIENCY rMS PROPERTY
COMP. PLAN ST. R/W S. XT. OALr--
indicated on
3
El 728
not
4
*V&� lcz_
Plan Check No ..................
PROPOSED USE
I
BUILDING
PLOT PLAN (IndICate iSUIldIng setbacks, abUtting streets)
PLUMBING
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 is correct; and that I am the owner, or the dUly author-
Ixed 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 PERMT
relating to Workmen's Compensation Inxur=ce.
AUTHORUES
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
Shan be completed in ninety days; MOVFJ)-IN BUILDINGS shall be oom-
plated In six months.)
SIGNED
INSPECTION
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 an the Public domain (curb@, sidewalks. driveways,
marquees, eta.) wit[ require separate pennission.
those
13 YES 13 NO
sit wi3.1 be revoked if septic
in not in our office on or
Valuation I Fee
M
No.
II (, -:�. 0-2- t C-n-
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or Ids Dep-
uty; and fees are paid, and receipt is ac-
knowIedged in space provided.
rum
az t
L
. ............
C,
C.f
All
outh 110. 0 ft. of tho Worltln 11.95.0 ft. of the Fast 189.0,ft-
of Trac4, R8
por Ion of Trae-Ilt. 105 lYir-a- of th(l "'"t alne
n to the Soxith 11,10 Of sa-ld Trant 105i P,Ist of Meado,,rdale Peach
s "of S'nohomish Crunt.Y, Washington.
'1,of tv I�pq,o ft, of t1hal 1port-ion of Tra Pla IL of
ne F
ast, ct 105,
%-crr,-%sh CoviAll, Washington, 7,ying Wast
le B ea cl i ' records of 5110.,
the Souih line
0 -no of Trac t 88 of salid Pliat imxtended '110
-the South 20.0
df,"; 16' Tra o 10" TXSS 'he No, th 195.0 Ct. and LESS
I f;
C
th-0- portion Of T.-a c t 10 5, Plat bf
-1sh Count�, WaShir;3"On, ying Wss�*
risar-,n.0 recOMS ol
st line of Tra c 41 98 of sajA lPlat extendod to 41--he South lin
...... .. � LF-7' the KIS'AP-9'O T",
a ct 1059 LET' the Norti; F5.0 ft . and E
Id' Tr,
f
I
thr� 'Vester! 11.0.0 ft., as MfIISUM an--lev, ai
_E,S tj '0 ft., th6reof
_1b Soijul, 20.
Ti-a c and
F
RECORD OF INSPECTIONS
Date Passed
Drainage
Sewer
Parking
Landscaping
Fire Dept.
I
7 71
ILI