690242.pdfPOSTED ON KROLL MAP NO.:
PERMIT
L
BUILDING DEPARTMENT
Applicant FIR
NUMBER 690242
PERMIT APPLICATION
inside Heavy Lines
JOB ADDRESS
NA,MM (OIL NAME OF BUSINESS)
SIDE YARD SETBACK
STREET
SETBACK REAR YARD SETBACK
&"IAD
RE
04
I TELEPHONE NUMBOE
E IONE
LOT AREA
VACANT
[] YES W1110
I— y CAI
'5 .
A6 -3 6 ))- - IGHT I BUILDING AREA I VARLALNCE NUMBER I
-3 6 ;? 2-
19 — N E iL cf t-7 I v 0 "eF Iv-
V I
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DNEW
RESIDENTIAL
AS
E
H
1
1:1
NON-RESIDENTJ
SIGN
ADD
0
DEMOLISH
4G
E,-�T
ER
R
EXCAVATE
OR FILL
FENCE
( x Ft.)
........ . .........
REPAIR
PRE -MOVE
INSP,
SWIM
El POOL
4UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
4. 1) 0 1� V_ -"�_ - .
EXISTING'STREET R/W ........... FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ........... FT. .--..FT . —
[] YES (3 NO
[] YES
�Jo 5'f"CTUg&k Clk��5
,5 U 6,3 Oc-'f -rb 51TU-=' IOSPc�CTIOI
06r-.
Plan Check No .................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
TtETAINING 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 to correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and a4ato laws regu-
ATTENTION
lating construction; and in doing the work authorized therAft, no person
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmans Compensation Insurance.
AUTHOIUZES
NOTE: Permit Limit One Year (Except DEI,�IOLITIONS which
ONLY THE
WORK NOTED
shall be completed in nluety days; MOVED -IN BUILDINGS shall be oom.
plated in six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
This Permit coven work to be done on private Property ONLY.
Any construction on the public domain (cwbs, sidewalks, driveways,
marquees, etc.) will require separkta permission.
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Vt5.:51W#N-\ - 'S
Valuation I Fee
I 4(ILI 1--76o
c9' do I VV I :;?. t) 0
Receipt
L/) VeN,
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-
lmowledged in space provided.
69
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