690196.pdfBUILDIIN DEPARTMENT Applicant M
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAmm OF BUSINESS)
C4 f. &A�� -
MAILING ADDRESS f
A 00/407 /w, ea. 2
CITY TELEviioNE riuMBER
1-77 5/- /-2 51-'—
til
-2�
POSTED ON KROLL MAP NO.: PERMIT
// 5- W I NUMBER 690196
JOB ADDRESS
;),0601
SIDE YARD SETBACK STREET SEWBAUK RE&R MW SETB,�Cli
S n 2,,� ::2 - I
-' I _'� �?J Al�
USE ZONE LOT AREA YACANT SITE
R X /a I (:) YES N(NO
Ed
EXISTING'STREET R/W .......... FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ....... ... XT. ............ 1".
VW4*-11
1�
E] NEW
ED--JLDD
ALTER
F.FPAM
B"RE SIDENTIAL
I NON-RESIDENTLILL J
DEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
INSP.
0
1:1
0
GAS
LINE
SIGN
RETAINING
WALL
PENCE
.......... Ft.)
swim
POOL
014-8CRECKED
NO
BY
D 3
Irti
REMARKS
NUMBER OF 13TORIES
NUMBER OF
DW7ELLING
UNITS
NATURE OF VKORK TO BE DONE
Plan Check No ............. ... ...
Valuatlol
.2
C1
BUILDING
PLUMBING
PROPOSED USE
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
FENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this 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-
lating construction; and in doing the work authorized thereby. no person
ATTENTION
will be employed In violation of the Labor Code of the State of WaAhingtou
THIS PERMIT
relating to WorkmeWs Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEBIOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
JIGNATURE (OWNER OR AGENT)
D TE SIGNED
NOTE: kicant Subject to Plan Check Fee
PR 6-1107
This Permit coven work to be done On private Property ONLY -
Any construction on the public domain (curbas sidewalks; driveways#
marquees, ate.) will require separate permission.
[3 YES [3 NO
No.
'00
WN 000
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.
D=ICVrO S BIG RE .4
DATE
In