690166.pdfPOSTED ON KROLL MAP NO.: PERMIT
690f66
BUILDING
DEPARTMENT Applicant FLU
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NUMBER
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F
Inside Heavy Lines
81
APPLICATION
7
JOB ADDRESS
A_J_
_-Ue�b
(OR NAME OF 4USINERS)
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,PERMIT
1
8IDJ,YARD SETBACK
STREET SETBACK I
REAR Y^itD SETBACK
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MAILING ADD
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ADDRESS
CITY
I TEELEN
z
or
NEW
RESIDENTIAL
GAS
LINE
ADD
NON-RESIDENTIAL
SIGN
RETAJZ-UNG
DEMOLISH
WALL
EXCAVATE
FENCE
ALTER
OR FILL
( X Ft.)
REPAIR
PRE -MOVE
�NSP.
......... . ........
SWIM
POOL
MMBER OF STORIES
NUMBER U
DWELLING
UNITS
13 YE13
r I
LOT UMA VACANT HITM
YES NO
I 13UILDING AREA. I VARLLNCM DIUMBER
STREET R/W .......... FT- DEITICIENCY THIS PROPERTY
LAN ST. R/W ............ FT. ....... .... IIT.
[] YES
FADb KPSTE(� ��
BR 1 77:-/ Plan Check
I
Valuation
Fee
Receipt No.
�P"ED USE
I BUILDING
1E-1?'S61k/191_ .
PLOT PLAN (Indicate Building setbacks, abutting streets) PLUMBING
HEAT A GAS LINE
FENCE
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLI"jION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formatlon given Is correct; :and that I M=m Me owner, or the duly author-
' U wo an
Ized agont of the owner. I agree to comply with city and state laws regu- ATTENTION
th W an Is
lating construction; and In doing the work autboriftzed tthareby, no person
Me Labo th la
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT
Ins ce
relating to WorkmerVa Co I mpensatlo; Insurance. AUTHOBIZES
0 ONLY THE
NOTE: Permit Limit One Year (Except DE51OLITIONS which WORK NOTED
'I co
VED_ ILD e COM
sluili brfo�npleted in ninety days; MOVED -IN BUILDINGS shall be ml
.1! In zfx Mont ) /11 "? / 0 It
(OPAR, INSPECTION
rx�� DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Platt Check Fee PR 6-1107
This Permit covers vrork to be done an private property ONLY.
Any construction an the public domain (curbs, sidewalks. driveways,
numquees, ate.) will reQuIre separate permission.
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.
DIRECTOR'S SIGNATURE
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