690233.pdfPOSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT
t Fill
Applicant Fill
NUMBER
PERMIT APPLICATION
ivy
Inside Heavy Lines
JOB ADDRESS
U233
NADIE (OR NAME OF BUSINESS)
]LInes
SIDE YARD SETBACK STREET SETBACK
REAR Y ETBACK
MAILING ADDRESS
N Z
SITE
2-
UBE ZONE LOT AREA
VACANT
CITY
'NUMBER
Ea
LTm�
YES No
1;
U, (09 ZV�;
HEIGHT BUILDING AREA
VARIANOM NUMIJbin PW
E4O
?��A LC_ kA
NEW
Rj RESIDENTU
R
GAS
LINE
NON-RESIDI NTIAL
SIGN
RETAINING
F]
El
WALL
DEMOLISH
ALTER
EXCAVATE
OR FILL
E]
FENCE
( x rt.)
.......... . ........
REPAIR
PRE -MOVE
INSP.
SMM
POOL
NUMBER OF
DWELLING
UNITS
v
E V
9TIWSTREET R/W .. . ....... FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. .......... IT.
21 L _j_/ I [] YES QrNO
'SPECRL INSACTOR REQUIRED OCCUPANCY GROUP
E3 YES W`5_0� I _:F. -y-
Plan Check 'No ............. .......
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINIITG WALL
SWIMMING Pool,
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby ack owledge that I have read this applicatlipthat 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-
ALTMNTION
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 PEB3nT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be earn.
plated In six monthfi.)
SIGNATURE (OWNER GENJ) DATE 131U ED
INSPECTION
11
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Chovk Fce
PR 6-1107
This Permit coven work to be done an Private Property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
m&rqufts, ate.) will require separate permission.
Valuation
"-_Fj
Fee
R71
No.
A
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-
knowledged in space provided.
FILE
a