680403.pdf00,
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POSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT 1_.Appucant Fill NUMBER 680403 �_7
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PERMIT APPLICATION Heavy Lines JOB ADDRESS
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REPAIR
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PRE -MOVE
INSP.
DWELLING
UNITS
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GAS
LINE
SIGN
RETAINING
WALL
PENCE
( .......... x . ........ Ft.)
swim
POOL
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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 -
tied agent of the owner. I agree to comply with city and state laws rogu-
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
relating to Workman's Compensation Insurance.
NOTE: Permit Limit One Year (Except DE31OUTIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS 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 dorman (curbs, sidewalksg driverways,
marquees, ate.) will require separate Permission.
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SIDE YARD SZTBAf
.F4qTREET SETBACK REAR YARD UETBACK
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[:I YES 13 NO
EXISTING STREET R/W ............ FT. DEFICIENCY TMS PROPER77
COUP. PLAN ST. R/W ........... XV. ....... .... FT.
[] YES [3 NO
I -Ian Check No ............
BUILDING
HyA6P3_11Q
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
Valuation
C] YES [3 NO
Fee
2
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No.
I IS700NO-a
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-
Imowledged in space provided.
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