690173.pdf... . .. . . ....... . .. I .
POSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant Fill NUMBER 690173
PERMIT APPLICA Inside Heavy Lines
-1 - -
(OR NAME or BUSINESS)
N E r3 PL� D DNtQR0Lj_
MAILING ADDnE1JB L)i
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F—TELEPHO-NE NUMBIM
TELEPHONE NUVREJ
ITY LICEN13E NUO
iw, Below or Attach Four Copies)
NEW
RESIDENTIAL
GAS
LINE
ADD
NON-RESIDENTIAL
SIGN
RETAINING
DEMOLISH'.
WALL
ALTER
EXCAVATE1
OR FILL
PENCE
( X Ft.)
........ . ..........
REPAIR
PRE -MOVE:
INSP.
El
SWIM
POOL
0
ra,
JOB ADDRESS i F
1?6c:� y.
81DE PARD 8 BACK 8TRI' ET SETBACK HEAR YARD SETBACK
- I n? 1 1.5, /-�?
LOT AREA VACANT SITE
USM
[3 YES NO Z
le.
13UILi5FN-G AREA I VrANCE )CUMBER r.
HEIGHT q74 4?,
13TREET a/W V V
EXISTING STREET R/W ............ FT.
raMP. PLAN ST. R/W ............ Fr.
ly
FIRE ZONE
I T7E OF CONSTRt
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8 PECIJ4a, irispzcToft RERUIRED
YES
dAe
PLAN CH C
Y
REMARKS
.
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Plan Check No ......... ........
PROPOSED USE I
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
22
HEAT &GAS LINE
FENCE
t
SIGN
N
RETAINING WALL
SWIM30NO POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formauon 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
TIUS PERMIT
relltUng to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE3101ATIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; I%IOVED-IN BUILDINGS shall be com-
pleted In six months.)
81 ATURE (0 ER OR AGENT)
E SIGNED
INSPECTION
j
DEPARTMENT
CITY OF
EDMONDS
NO�E: APPlicant Subject to Plan Check Fee
PR 6-1107
This ]Permit covers work to be done on private property ONLY.
Any construction on the public domain (carbs, sidewalks, driverways,
marquees, etc.) will require separate permUslon.
I
9
7 SbIt
IUffi
THIS PROPERTY
OR
STREET IMPROVED
13 YES 0416__�
Fee
FIMP-0
ki�'. e2e!57 V*M
APPLICATION APPROVAL ,
This application is not a permit until
signed by the Building official or his Dep-
uty; and fees Eire paid, and receipt is ac-
Imowledged in space provided.
rum
D ate PAsi I ed
Drainage
C:V. All"
Sewer
Parking..
Landscaping
Fire Dept.
9
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