690052.pdf4
UILDING DEPARTMENT
PERMIT APPLICATION
POSTED ON KROLL MAP NO.:
PERMIT
NUMBER
Applicant Fill 1 690052
Inside Heavy Lines cc)
jOB ADDRESS
gig
1,6d
SIDE YARD
SET:A�CKSTnEET
SETBACJ�.
REAR YARD SETBAU1117
ONE NUMBMR T 7'
LOT AREA
VA ANT SITE
a 0
BUILDING AREA
VQkRL4LNCM �11.
- 3 Z 0;? HEIGHT
1Q:)Z_0 1- (03-22 1 -
L,effal Description of Property (ShoW Below or Attach Four
if - it
RESIDENTLA L
GAS
LINE
NEW
ADD
NON-RESIDENTIAL
SIGN
DEMOLISH
RETAINING
WALL
ALTER
EXCAVATE
FENCE
OR FULL
PRE-MOVn
( x Ft.)
swim
REPAIR
INSP.
POOL
ilt U�
DWELLING
UNITS
rATuRE OF woRx To -BE DoNE
-B_ i—W -
ISTING STREET R/W EMCIENCY THIS P]
!OUP. PLAN ST. R/W -A*&XT. FT.
-ARK5.
Driveway slopes not to exceed those
indicated on Standard Drawing #103.
[3 YES
Plan Check No ...................
PROPOSED USE
BUILDING
U'r PLAN (Indicate Building setbacks, 'butting streets)
PLUMBING
HEAT & GAS LINE e4
FENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION on FILL
TOTAL AMOUNT DUE
I 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-
lating construction; and in doing the work authorized therebr, no person
ATTENTION
will be employed In violation Of the Labor Code of the State of Washington
THIS PERMIT
relating: to Workman's Compensation Insurance.
AUTnOWzEs
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
shall be completed to ninety days; MOVED -IN BUILDINGS shall be com.
WORK NOTED
pleted In six months.) A
IIGNATSRE (OWNER 0 I/A7GT)-
DA E SIGNED
INSPECTION
7T;7
6
DEPARTUP14T
CITY OF
EDMONDS
NOq: APPlicant Subject to Plats Check Fee
PH 6-2101
This Permit covers work to be dont. an private Property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
manu6es, etc.) will require separate permission.
[3 YES
Valuation I Fee I Receipt No.
t-
0 IN ?1q9
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-
Imowledged in space provided.