690144.pdfU
POST
BUILDING DEPARTMENT Applifiant I
Inside Hcavy:nes 7_05 j
PERMIT APPLICATION
61-1—
LT -,/ - 7-5-6S'
1-2--3 0/ �5_0 7 / I
L,ogai DeacTIptiOn Or Yroperty (Show Below or Art
/ t . 6 -7' 2 g I V -2
3S' 3,T'
RESIDENTLI
GAS
LINE
F-1 NEW
H
NON-RESIDI TIAL
SIGN
JLUV
REMAINING
WALL
DEMOLISH
ALTER
M
EXCAVATE
OR FILL
PENCE
( x Ft.)
........ . ..........
REPAIR
M
PRE -MOVE
INSP.
El
swim
POOL -
ES
NUMBER OF
DWELLING
UNITS
!D ON KROLL MAP NO.: PERMIT
NUMBER 690144
DDRESS
I/ 2_0 7-4 T U)
YARD SETBACK STREET SETBACK _ItEAR YARD SETBACK
;d,
ZI 04415
LOT AREA YES )5( NO
3T?4Q AREA I VARIANCE NUMBER
STREET R/W
EXISTING STREET R/W ........ .. X'V- DEFICIENCY TMS PROPERTY
COMP. PLAN ST. R/W ........... . FT. .......... FT.
[I YES
Plan Check No ...................
USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
FENCE
SIGN
RETAiraNG WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TWAL AMOUNT DUE
I hereby acknowledge that I have read thin 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 PEILIHT
relaring to Workman's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TIM
WORK NOTED
shall be completed in ninety days; MOVED-XN BUILDINGS shall be com-
plated In nix months.)
—N
jlnrjA.TURE (OWNER OR AGENT)
DATE SIGNED (a
INSPECTION
DEPARTMENT
7 La&g
2-(�
�4' �6/,/
=�
CITY OF
���
U
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any comptructlon an the public domain (curbso sidowalkso drivenvayst
marquess, ate.) will require separate perwileslon.
Valuation
®R
YES 0 No
Ire a
Z
I
No.
APPLICATION APPROVAL �
This application Is not a permit until
Signed by We Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
lmowledged in Space provided.
Fax