680390.pdfr t o
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BUILDING DEPARTMENT[
PERMIT APPLICATION
Applicant Fill
Inside Heavy Lines
It
POSTED ON IMOLL MAP
p
JOB ADDRESS
NO.:
PERMIT
NUMBER,
I
680390
MAKE (OR NAME OF BUSINESS)
Ar Ir 6�" /I/
SIDE YARD SETBACK
t� 0 1
/a Z")
STREET SETBACK
;I
REAR YARD SETBA
-1)7) ,
A�
MAILING ADDRESS
ZONE
LOT AREA
VACANT SITE
0 NO
CITY
TELEPHONE 14UMISJIIK
4G-4,"?
_r -7
HEIGHT
BUILDING
AREA
rVARIANCE NUM13EII
pq_,:? _? 41 1 ,
I Legal DescriptM,
-/L Z) -),- -?
M—NEW
El ---
ALTER
REPAIR
N MIS
U ER OF S;
on
1
62�t`
'- 1.2- a
RNESIDENIDAE
I
AS
rE
JTL
SIGI
DEMOLISH
RETAINING
WALL
EXCAVATE
PENCE
OR PIM
( .......... X .. ....... Vt.)
EPnE-MOVE
I
El
SWIM
INSP.
POOL
lEs
NUM13ER OF
DWELLING
UNITS
,IT ---
STREET R/W 10--.11-37.
DEFICIENCY THIS PROPERTY
... 0L.FT.
indicated on Standard Drawing #103.
[] YES )m NO
Plan Check No ........
BUILDING
PLUMBING
BEAT & GAS LINE
PENCE
T SIGN
N
RETAINING WALL
4 SWIMMING 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-
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 PERMIT
minting to Workman's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
6 Of /_
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fce
PR 6-1107
This Permit coven work to be dam on private property ONLY.
Any construction on the public domain (curbs. sidewalks, driveways,
marquees, etc.) win require separate perndsslon.
Valuation
13 YES [3 NO
Fee
0
No.
I ��6 1.-(146 oe
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.
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