680458.pdf. .........
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P STED ON KROLL MAP 140.: PERMIT
111.111DING DIPARTMINT Appl1clant Fill 0 1 NUMBER 680458
Inside Heavy Lines JOB ADDRESS
PERMIT APPLICATIM I M P
I NAME (OR NAME OF BUSINESS) 77,�l / — C:-) //(;� Y. (V -
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YAR? SETBACK
iSTRNET SETBACK
REAR YARD BETPACK
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USE
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LOT A.ItEA
VACANT BITE Pe
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YES )9(NO
IHTTI1,11ING
AREA
I VARIANCKNUMBER RA
NEW
RESIDENTIAL
I
M
GAS
LINE
NON-RESIDENTIAL
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SIGN
ADD
RETAINING
WALL
DEMOLISH
EXCAVATE
PENCE
ALTER
OR FILL
( X Ft.)
REPAIR
El
PRE -MOVE
INSP.
.......... ..........
swim
POOL
iUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
4t'kA�
No. STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT.
0 YES
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
RETA.INING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
1 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
tating construction; and In doing the work authorized thereby, no person
will he employed In violation of the Labor Coda of the State of Washington THIS PERMIT
relating to Workmeaa Compenattlon. Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUHMINGS shall be com.
plated in six months.) INSPECTION
TI—ONATURE (OWNER 0 NT) DATE SIGNED
DEPARTMENT
CITY OF
EDAIONDS
NO& Applicant Subject to Plan Check Fce PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curb$, sidewalks, driveways,
marquees, etc.) wIH require separate permission.
13 YES
Fee
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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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