690193.pdfI
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POSTED ON KROLL MAP NO.: PERMIT
690193
BUILDING
DEPARTMINT
Applicant Fill
I NUMBER
PERMIT
F_NAXIM
APPLICATION
Inside Heavy Lines
I
jop
0 (y -ck Iq
(on NAME
ol
OF BUSINESS)
'?'M " 1'n
SIDE YARD SETBACK I STREET SETBACK REAR
YARD
I
7//1
9 A
./,5? 7-
- &* 76 1.--,
EXISTING STREET R/W ............ FTI
COMP. PLAN ST. R/W ............ IT -
[] YES
aftj
DEFICIENCY THIS PROPERTY
13 YES vfo__�
I V
I
GAS
El RESIDENTIAL LINE
I El
0 YES wlq�o
El NEW -
191 7,1ON-RESIDENTIAJ
PLAN CHECKED BY
SIGN
F-1 ADZ) RETAINING
WALL
1:1
DEMOLISH
OALTER EXCAVATE FENCE
1:1 OR FILL ( ........ . x .......... Ft.
REPAIR PRE -MOVE SWIM
INSP. POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Valuation Fee Receipt No.
Plan Check No ............ .... ...
PROPOSED USE
BUILDING
0
5
000'1'__
—ILbutting
.
00
PLOT PLAN (Indicate Building fietbacU, streets)
PLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
00
I hereby acknowledge that I have read this application; that the in-
formation given In 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-
ATT Er-MON
APPLICATION APPROVAL
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
TILIS PEIDUT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep
NOTE: Permit Limit One Year (Except DE51OLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVEB�IN BUILDINGS shall be core.
lanowledged in space provided.
pleted litatz mont�� ,,
I - AT RE (0 E O�ENT) DATE SIGNED.
INSPECTION
DEPARTMENT
DIRIE10-TrOR':S _SIONATUftE
OF
CITY
EDMONDS
NOTE: APpli"?jt Subject to Plan Check Fee
PR 6-1107
This p Mdt coven work to be done on private property ONLY.
Any congtMettoll an the public docaaln (curbs, sidewalks, driveways,
marquees, ate.) will roqwrc separate permission.
rum
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