680438.pdf. a
—Fo—WrEDON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant Fill -2 NUMBER 680438
PERMIT APPLICATION Inside Heavy Lines EBB
o g NAME 43F BU NE08) V 3 Pt
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SIDE YARD SETBACK STREET BETIJAUIS
MAILING ADDRE13B op
S 7' URF1_Z A VACANT BIPXAJ
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0 rlu"rnurt= IT YES NO
Ir2_ Ar—j HEIGHT BUILDING AREA VARIANCE N
NAME —fL—OTPLAN APPROVED
0
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LOT ARE
ZmIN N BER
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JFD—DRESS
STREET R/W
Mj El
CITY TELEPHONE NUMBER EXISTING STREET R/W FT- DEFICIENCY TIUS PROPERTY
COUP. PLAN ST. rr.
REMARKS
NAME Driveway slopes not to exceed those
g indicated on Standard Drawing #103.
C4 DRESS Z
9 CHECKED BY
CITY UMBER
Z
METER SIZE SERVIC SIZE CLEARANCE CAE;;J��
USER
STATE LICENSE NUMBER I CENSE NU
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Legal Description Of Property (Show Below wr —Attach Four copies)
16 7— R A TYPE CONNECTION VERJJ�.
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5ER
PERO. TIST PERM��UMBER
REMARKS
C1 FIRE Z TYPE OF CONSTRUCTION REET IMPROVED
YES [3 NO
GAS
V9--NEW RESIDENTIAL 0 LINE
NON-R.ESIDENTIAL SIGN
DRETAINING
0 DEMOLISH WALL
ALTER EXCAVATE PENCE
F� OR FILL ( .......... x .......... Ft.)
REPAIR PRE -MOVE SWIM
1:1 INSP. POOL
ES NUM13ZkC OF
DWELLING
UNITS
C] YES
Plan Check No .....................
PROPOS Ter= BUILDING
PLOT PLAN (Indicate building net)raW,&uttlng street,) PLX13MXG
HEAT & GAS LINE
PENCE
t SIGN
N
RETAINING WALL
SWIMMING POOL
OLITION
PRE -MOVE INSPECTION
Id
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby neknowledgo 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- ATTENMON
Idling 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. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DE51OLITIONS which WORK NOTED
shall be completed in ninoty days; MOVED -IN BUILDINGS shall be corn-
pleted In six months.)
SIGNATURE (0 IENT) DAT SIGNED INSPECTION
IF A"04 11-e CITY OF
DEPARTMENT
A EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 0.1107
This permit covers work to be done od private Property ONLY.
Any construction on the Public donuUn (curb@, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation
39'.
Fee
No.
I A/5105,40162711"/
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-
knowledged in space provided.
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