680445.pdf. . ..... . . . ...
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I hereby acknowledge that I have road thin application; that the In-
formation given In 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
relating to Workmen's Compensation Insurance.
AUTIIOIUZES
NOTE: Permit Umit One Yeur (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
plated in six months.)
(0) VWTN N DATE SIGNED
INSPECTION
16�
DEPARTMENT
/L
UITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Pertrdt covers work to be done on private property ONLY.
Any construction on the public domain (curbst sidewalks. driveways,
rnarquees, etc.) will require separate permission.
BUILDING DEPARTMENT Applicant FIII
Inside Heavy Lines
PERMIT APPLICATION
INAME (OR NAME OF BUSINESS
P SI
�, Al Al Q=C�
1 FMAMJNO ILDDRESS
ty J C
MA
_6 &I
ON
KROLL MAP NO.:
PERMIT
/
.2 0
NUMBER
68044tr57
RES8
,RD
SETBACK
STREET SETBACK
REAR y"D SOM
1
rh
i'q,, .
-;� 51
A ,
�� 11
I
A 5 M/-q-
NE
LOT AREA
VAC�x SITE
�
f _n�
I
1 0 YES 0 NO
MA... ../ "
EXISTING STREET R/W 16- FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W.5*AXT-
FT.
REMJkRKS
Drivewav slories not to exceed those
indicated on Standard Drawng. #103.
.�3/rt (, 1 3/4,it
FIRE ZO I TYPE OF COr,
JM I
SPECIAL INSPECTOR REQUIT
[:] YES NO
Eg�RER'IDENTIAL
GAS
LINE
PLAN CHEM BY
---
ALTER
REPAIR
E] NON-RESIDENTLILL
ElDEMOLISH
EXCAVATE
1:1 OR FILL
PRE -MOVE
1:1 INSP.
SIGN
RETAINING
WALL
FENCE
( ........ . x ......... Ft.)
swim
POOL
—A—EMARKO
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Z
Plan Check No ..................
Q
PROPOSED USE V
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
of
HEAT & GAS LINE
FENCE
t
SIGN
V-f
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
;�- q ts, —
TOTAL AMOUNT DUE t f r-
114 (0 1.3, 0 1 \1 %0 -1
Valuation
dl�l // �',
A=
Z
L
APPLICATION APPROVAL
This application Is not a permit until
signed by Uie Building Official or Ms Dep-
uty; and fees are paid, and receipt Is ac-
Imowledged in space provided.
"