690060.pdfPOSTED ON KROLL MAP NO.: PERMIT
NUMBER
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690060
BUILDING
DEPARTMENT
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Applicant F111
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PERMIT
APPLICATION
Inside Heavy Lines
JUB ADDREUS
NAME (OR NAME OF BUSINESS)
I P-tu'dSe iJ
SIDE YARD SETBACK
SwREEr SETBACK
REAR YARD SETBACK
MAILING ADDIM015
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AREA
VACANT BITE
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EXISTING STREET R/W 0 ... FT.
DEFICIENCY THIS PROPERTY
CITY
TWLEPHONE NUM13MIL
COMP. PLAN ST. n/w.,�,.e.xv.
FT.
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REUARKS
NAME
C'
Driveway slopes not to exceed those
C'0_t%_e_
indicated onStandard
Drawing #103.
ADDRESS
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14
CITY
WELZMONE NUMBER
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—NUMBER
IZE SERVI SIZE CLEARANCE CI&JRff.D BY
STATE LICENSW NUMBER
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CITY LICENSE NU ER
174
REMARKS
Legal Description of Property (Show Below
or Attach Four Copies)
TYPE CONNECTION
VE Y
of C I?-
10 C-1- umf= /'45�pkt
PERC. TEST
PERMIT NUMBER
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NEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
SIGN
ADD
RETAINING
WALL
DEMOLISH
ALTER
EXCAVATE
OR FILL
PENCE
( ........ . x .......... Ft.)
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
rUMBER OF STORIES
NUMBER OF
DWELJANG
UNITS /:i U
�7RE ZONE =PE
�' I
[3 YES Erlio
Plan Check No ..................
BUMDING
PLOT PLAN (Indicate Building setbacks, abutting Streets)
PLUMBING
BEAT & GAS LINE
PENCE
SIGN
RETAINING WALT
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
i-A)
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-
ATTENTION
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
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEIZOLITION13 which
WOIM NOTED
shall be completed in ninety days; MOVED-XN BUILDINGS shall be com-
pitted In six month@.)
BIG TURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
4S __ Q
DEPARTMENT
/ 1�
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
his Permit covers work to be dom, on private Property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require tepamta Permission.
[] MS
Fee
No.
490 .06
APPLICATION APPROV
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.
UffEECTOR'S 'SIGNATURE. -2
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Fam