690099.pdf. j
OLL MAP NO.: PERMI
POSTED ON KR T
NUM13E
DR 690099
FBUILDING DEPARTMENT Applicant FM
P
I;t
SIDE YARD SETBACK STREET SETBACK SETBACK
Inside Heavy Lines jOB ADDRESS
PERMIT APPLICATION 5"/1
77
NAME (OR NAME O��DUSINESS)
n /7-/,l
1:1 NEW
ElADD
ALTER
REPAIR
V-1
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s / .—
HONE N_PMI
,7�?
C
RESIDENTIAL
[:]
AS
NON-RESIDENTIAL]
f
alai:
DEMOLISH
XCAVATE
E OR FILL
F
RETAINING
WALL
FENCE
PRE -MOVE
INSP.
FI
swim
POOL
DWELLING
UNITS
Yk I
t
N
I
I hereby acknowledge that I have read this application; that the in-
formation given to correct; and that I am the owner, or the duly author-
lzed 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 DEMOLITIONS which
shall be completed in ninety days; MOVEDAN BUILDINGS shall be com-
pleted In six months.)
F. /r-,-n
NOTE: APPlicant SubjKct to Plan Check Fee
This Pm t covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways.
marquees, etc.) will require separate permission.
USE ZONE AREA VACANT SITE
I [:I YES [3 NO
I VARIAN1319 VU-1 Z4% 19,
/111�0 I �
=N'TREET R/W ............ Fr. I:)EFIcrENcy THIS PROPERTY
coup. PLAN ST. R/W ............ PT . . ............ In.
or
[:] YES
Valuation
0 YES
Fee
b,-N,o
No.
FIAD Check No ............. .. ....
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
jWs application is not a pernitt until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
Uty; and fees are paid, and receipt is ac-
WORK NOTED
knowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107