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173—REDON
PERMIT
KROLL MAP NO.: NUMBER 680505
BIUILDING. DEPARTMENT Applicant Fill
PERMIT APPLICATION
Inside Heavy Lines JOB
ADDRESS C;2 / C) cQ
NAME (OR NAME] OF BUSINESS)
SETBACK
STREET SETBACK
REAR YARD SETBACK
GrAtrAlff,jit. —FI—DEYARD
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1
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0 ADDRESS
USE ZONE
LOT AHNA
O'L' J"'
VACANT SITE
4it 19-6 RACEr-1
dn ., , r
YES NO
CITY
T ONE NUMBER
HEIGHT
BUILDIN Q
�ARE
RIANCE NUMBER
-L&A-0
P.
Coma X14
774
NAME
PLOT PLAN APPROVED
cr
STREET R/W
EXISTING STREET R/W ........... FT.
eZrICIENCY THIS PROPERTY
'ENE I A
TELEPHONE NUMBER
COMP. PLAN ST. R/W ............ FT-
............
REMARKS
iw 4
Z
CHECKED BY
or
aw
GAS
E] NEW [YRESIDENTIAL R LINE
11:1 NON-RESIDENTIAL D SIGN
ADD RETAINING
�T El DEMOLISH WALL
En EXCAVATE FENCE
D OR FILL D ( .......... x .......... Ft.)
REPAIR PRE -MOVE swim
INSP. POOL
NUMBER OF
DWELLING
UNITS I
r-04
9
Cj YES [] NO
OF
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Plan Check No .... . ...............
PROPOSED USE
Q X CAM 6-AAAkl-
BUILDING
PLUMBING
-FL—OT PLAN (Indicate Building setbacKs, aDUEEing strects)
HEAT & GAS LINE
FENCE!
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
I hereby acknowledge, that I have road this application; that the In-
formation given to'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-
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 Workmen's Compensation Insurance.
NOTE: Permit Limit one Year (Except DE31OLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS ahall be com.
ATMNTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
pleted In six months.) A
IN SPECTION
DEPARTMENT
CITY OF
_�(F_
SIGNATURE (OWNER Oil GENT)
_� P ,
AL-'a�
DATE SIGNED
1 11114-1(0 e
EDMONDS
NOTE: Applicant Sitbjcct tAlan Check Fee
pit 6-1107
Title remit coven work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
nucequees, etc.) will rAulre separate permission.
,^ et
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0 YES [3 I -TO
Fee I Receipt No.
6, 0 1 0
APPLICATION APPROVAL
This application is not a perinit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
FILE
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