690047.pdfV
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POSTED ON KROLL MAP
BUILDING DEPARTMENT Applicant Fill IAO t
PERMITAPPLICATION Inside Heavy Lines joll ADDItEse
.PU"RR NAME OF BUHINEUB)
SIDE YARD SETBACK I
C
USE^NE
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2,5-61-7"?e97
Legal Description of Property (Show Below or
72� 601,
W R4_JC?,6
—Rig
GAS
RESIDENTIA LINE
is NEW NON -RESIDE; TIAL SIGN
EJADD RETAINING
DEMOLISH WALL
ALTER EXCAVATE PENCE
OR FILL ( ........ . X .......... Ft.)
REPAIR PRE -MOVE swim
INSP. POOL
rUMBER OF STOIUES NUMBER OF
DWELLING
UNITS
PERMIT
NUMBER
5�1
69004
A/.
131TE
13 NO
'El NUX'
; t " -
STREET DEFICIENCY TH113 PROPERTY
PLAN ST. R/W6._..0 ... FT.
indicated on Standard Drawing #103.
[] YES
I I 'z/d tt
'* Y/-<j "14
0 YES M40-
'o
Valuation Fee Receipt No.
Plan Check: No .................
I0 PROPOSED USE
0
BUILDING
4% 06 (a 6-% old
M
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
that I have read thh; application; that the In-
TOTAL AMOUNT DUE
0
I hereby acknowledge
formation given 1B correct; and that I am the owner, or the duly author-
ized agenl� of the owner. I ease to comply with city and state laws regu-
ATTENTION
APPLICATION APPROVAL
lating nonstmetion; and In doing the work authorized thereby, no parson
will be amPlOyid in �olathm of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
ral�g Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
;o/VTrk:enLX,,1
n __It
N (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt Is ac-
be cc leted LWD sty days; MOVED- UILDINGS shall be com.
knowledged in space provided.
plat in 81 months.)
RONATU (OWNER 0 ENT) D TE SIGNED
INSPECTION
DIRECTC��R/MIHQN
AR
DEPARTMENT
CITY OF
Subject to Plats Check Fee
EDMONDS
DA
lie
OTE: APPlicant
PR 6-1107
This permit coven worx w . ono on private property ONLY.
domain (curbs, sidewalks, driveways,
Any oongtructloa on the public
malquaes, etc.) wtu roqutm separate permission.
FILE
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