680423.pdfC, C !
POSTED ON KROLL MAP NOA PERMI
UILDING DEPARTMENT es NUMBER 69i
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
4A" OF INESS) 5
SIDE —YARD SETBACK STREET SETBACK REAR YA
W!ANG A�DDREHJS Z)
VACANTE
Ab us
(M YES
I TELPPHO"E NUMBER
IP-)vt/7137 HEIGHT UU-1—LDING ARETL VARIANCI
0�w Z�_
Legal Description of Property (Show ISeLOW or At on Your uo'VIC5)
of
GAS
EINEW RESIDENTIAL LINE
NON-RESIDENTIAL F� SIGN
lu
RETAINING
MDEMOLISH WALL
EXCAVATE FENCE
ALTER
F] OR FILL ( .......... x ..........
REPAIR PRE -MOVE swim
INSP. POOL
NUMBER OF STORIES
N UMBER OF
DWELLING
UNITS
12,*6
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 laws regu-
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 Workinen-a Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; MOVED-XN BUILDINGS shall be com-
pleted In_" months.) ,
NOTE: APPlicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction an the public denude (curbs, sidewalks, driveways,
mariluces, etc.) will require separate permission.
EXISTING STREET R/W ............ FT.
COUP. PLAN ST. R/W ........... XT-
ZONE
0 YES
13 NO
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
C
DEFICIENCY THIS PROPERTY
[J YES 13 NO
Valuation I Fee I Receipt No. I
M,
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES
ONLY THE signed by the Building Official or his Dep-
WORK NOTED uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 6-1107
DATE
FILE
r
r .
i
"PIJOAMON MILONG MNff Appl. No.
Cffy OF EDMONDS
SaUdIn Dep="WW Permit limit. one vmr
with the acood!
AFFMA11ION is hereby made for a permit to construct the following work, in accorda=
panying plans and specifications. Two sew are submitted herewith for approval.
ew alter ff'St.
0
n ............... Parking ......................
k, addh repair ..................
............................................
Use zone ...... e::L5� .... ... Fire zone ...........................
... Const. typf . ...............................
pan ...............................
Fy,
. . ...... Addn ......................................
64
resk .01 ................. Blk .....
...........
AArea. .................. . ....................... Septic tank .........................................................
....................................... A
front........................... r. side ............................. 1. side .............................. rear ...................... ............
:-Addrm ..... Tel. N . .............................
er . . .. .. . .......
-Ider ................... .............................................. Address ................................................... Tel. No ..............................
..................... Tel. No .............................
Plans by ................................................................. Address ...............................
Remarks..................................................................................................................................................................................
.................................................................................................................................. .............................................................
..........................
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work.
............... ....... Date..��
Signed Owner/Agen ....... :-.z
-44ddress ................... . .
is with the ap,
PIRMff for the above work hereby approved, subject to the above conditions, and to compliance
proved plans and specificatiorA and Building Department notations thereon.
it fee . .......... . I�z ............ Recd
..........
............... P
Valuation .......... by ...... I . . ......
................ . . .. ... . .................. Date ................... ........................
Building Departmintj By .............
NOTE This permit does -not cover plumbing. sewer, or electrical installations, nor does It Permit any work to be
done in the Right of Way areas. Driveways and walkways must be planned to meet the official grades of streets
and alleys, and plans for future sidewalk development