680543.pdfPOSTED ON KROLL MAP NO.:
PERMIT
680543
BUILDING
DEPARTMENT
Applicant Fill
lu-
NUMBER
/ ;1. 0
PERMIT
APPLICATION
Inside Heavy Lines
JOB ADDRESS
W
M
VWT tu JV1171?-� -e' �-
ADDRESS
CITY TELEPHONE NUMBER
Lseiow or
A
SIDE YARD SETBACK STREET SETBACK nNAR YARD SETBACK
A
'0 Z'�j - -:� .5"
IMSEQ NE LOT AREA VAUA�K SITE
a IsI �11 I I P(—T-FS (:I NO
I BUILDING AREA I 'VARIANCE NUMBER 04
��MGA* STREET R/W —TAOUT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W'S.O.XT. ... Q ... FT.
indicated on Standard Drawing #103.
3 lei. 1;
GAS 0 YES &1110�_
NEW zLRESIDENTIAL LINE PLAN C
1:1 No El SIGN
ADD RETAn-71NG IMMARjW-
1:1 DEMOLISH WALL
ALTER EXCAVATE PENCE
E] OR FILL I .......... X .......... rnt.
REPAIR PRE MOVE SIVIM
1:1 INSP. POOL
4UMBER OF STORIES NUMBER OF
DWELLING
UNITS
.ITATURE OF WORK TO BE DONE
Al r: k..- C o /,./ < 7- /f Ll c 7'� '" I Ul
4 1 a 1-17 AA i L 7
Plan Check No ..................
e*'� 'C2 Yo
BUILDING
PLOT PLAN (Indicate 1pild4gir setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
N
RETAINING WALL
4 0 7-
IB*I?A NO POOL
lei 3 .9 2 —10 q 4 14(
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby ackno?WlAgd��t I have read this 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-
ATTENMON
lating construction; and in doing the work authorized thereby, no person
will be employed In violation of tha Labor Code of the State of Washington
THIS PER51IT
ralaUng to WorkmeWs Compensation Insurance.
AUTHOR[ZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
ATURE (OWNER Olt CENT)
DATE SIGNED
INSPECTION
DEPARTMENT
'3-
14g—
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PH 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permisslon.
Valuation I Fee
L -) 10
0 NO
I
In
No.
I / 17,5^0 1 #,q 91
APPLICATION APPROVj�!. �
This application Is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
lmowledged in space provided.
I