680361.pdfPOSTED ON KROLL MAP NO.: I PERMIT
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BUILDING DEPART ENT Applicant 1; NUMBER 680361
PERMIT APPLICATI N Inside Heavy Lines JOB ADDRES0
N ME (OR NAME OF BUSINESS)
9 a D. 7
A M 4- SIDE YARD SETBACK STREET SETBACK REAR yAlti.) SETBACK
I I 1 0
rn J_� .1 '2y %
P�'
91
9 1-1: �'� <" C-�
-� — 19
T,
�
CITY
HONE NUMBER
NAME
0 A—,
1
N
ADDRESS
TELEPHONR
ONE
-) t'.Vi. I / 5, W)'k
[] YES [3 NO
EXISTING -STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. .......... FT.
FIRE ZONE TYPE OF
SPECIAL INSPECTOR REi
El RESIDENTIAL
GAS
LINE
C] YES [] NO
NEW
1
PLAN CHECKED BY
11
NON-RESIDENTL4.L
SIGN
RETAINING
REMARKS
0
WALL
r ALTER
D
DEMOLISH
EXCAVATE
OR FILL
FENCE
( .......... x . ........ Ft.)
El REPAIR
El
PRE -MOVE
INSP.
El
SWIM
POOL
NUMBER OF STORIES
NUMBER or
DWELLING
UMTS
NATURE OF WORK TO BE DONE
Plan Check No .....................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting
streets)
PLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formsuou given In correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply With city and state laws regu- AITENTION
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. AUTHOIUZES
ONLY THE
N43TE: Permit Limit One Year (Except DEMOLITIONS Which WORK NOTED
shall be completed in ninety days; MoVFJi,_IN BUILDINGS shall be eom-
pleted in six months.) INSPECTION
DATE SIGNED
FIM4ATURE (OWNER�_!R AGENT) DEPARTMENT
'T ao-L,,, t) I q6P
CITY OF
EDMONDS
NOTE: Applicant subject to Plan Check Fee PR 6-1107
This Permit cove" WorK W M .... .. ONLY.
Any construction on the public doravin (curbs, sidewalks. driveways,
marquee,,, ate.) will require separate permission.
Valuation
[3 YES [3 NO
Fee
0 e?
9,00
APPLICATION Ah"PROVA
This application is not a pernilt until
signed by Me Building official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
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