690245.pdf... .. ..... .. ..... .......
POSTED ON KROLL MAP NO.:
PERMIT
NUMBER
�441� BUILDING DEPARTMENT Applicant M I
Inside Heavy Lines JOB ADDRESS
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PERMIT APPLICATION 7W)
NAME (OR NAME OF BUSINESS)
A dr,
'SIDE
YARD SETBACK
.
IET SETBACK REAR YARD SETBACK
Cd
MAILING ADDRE1111 -T-
_US EF
VACANT SITID
0 YES [3NO
CITY
W A 5/1,
TIBLEX-RUNE NUMB
17
Hal G HIT
BUILDING AREA, VARIANUN r4u�zl%
04
NAME
PLOT PLAN AP OVED
ADDRESS
STREVVR/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... XT. ........... 'T.
CITY
TELEPHONE NUMBER
REMARKS
NJI M
Z
ADDREUB
;2 .2,)
CHECKED BY
_nlm� - I TELEPHONE NU�MBER
Z
I
M
or
NEW
19 RESIDENTIAL
M
GAS
LINE
ELINON-RESIDENTIAL
SIGN
ADD
RETAINING
RDEMOLISH
WALL
EXCAVATE
FENCE
ALTER
F1
OR FILL
( x Ft.)
REPAIR
_1
F
PRE -MOVE
INSP.
........ . .........
SMM
POOL
IUMBER OF STORIES
_]INi 11 M B E R 0 F
DWELLING
UNITS
FIRE ZONE I TYPE
SPECIAL INSPECTOR
[j YES 13 NO
Plan Check No ..................
PROPOSED USE
0,
BUILDING
4 too 4 7—
PLOT PLAN (Indicate Building Setbacks. abutting streets)
PLUMBING
BEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWII, NG POOL
V_
DEMOLITION
zj�
PRE -MOVE INSPECTION
EXCAVATION OR FULL
TOTAL AMOUNT DUE
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-
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
THIS PRIOUT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Umit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVEDAN BUILDINGS shall be com-
pleted in six months.)
rI-GNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
Orry OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 8-1107
This Pertnit covars work to be done an privitta property ONLY.
Any construction on the public domain (curbs, sidewn3ka, driveways,
marquees, ate.) Will require separate permission.
13 YES 13 NO
Valuation
C) C,
APPLICATION APPROVAL
This application Is not a permit until
algned by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
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