690248.pdfBUILUMV utrAKIMCIII I Applicant1rill
DCDAART APPIWATI(IM I inside Heavy Lines
----NAME OF BUSINESS)
NAMID (OR
VA tlf�o k 4L X
rL &%0 o cq 4/
I Pr / L3 to � �
'n� 4.3 1 At
or
...........
. . . . . . . . .
D ON
KROLL MAP
NO.: PERMIT
NUMBER
6c)n24B
YARD
SWrBACK
STREET SETBACK
REAR YARD BET13ACK
L07T 'TAREA
VACANT SITE
[j YES No
I BUILDING AREA
I VARIANCE NUMNE—R.
P4
G�-8;�NG'ST-REET R/W ............ FT- DEFICIENCY THIS PROPERTY
VmMP. PLAN ST. R/W ............ FT- ............ IV. —
RESIDENTIAL
GAS [] YES El NO
LINE
NEW
PLAN CHECKED BY
NON-RESIDENTIAL
SIGN
RETAINING EMARKS
WALL
ALTER
DEMOLISH
EXCAVATE
OR FILL
PENCE
x Ft.)
.......... ..........
REPAIR
�INRE �OVE
.9
SWIM
POOL
J�
E
NU9TE_R OF
DWELLING
UNITS
4
Plan Check No ..... ........... ...
BUILDING
PROPOSEDUSM
PLUMBING
.jBUI
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
12
PENCE
SIGN
t
RETAINING WALL
:N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FULL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that the In.
formation given to correct; and that I am the Owner, or the duly author-
IzLd 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 PERMIT
relating to Workman's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com.
pleted In mix months.)
3IGNATURE (OWNPR R 3JENT DATE SIGNED
7�/ y
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
V4OTF: APPIVant Subject to Plan Check Fee
Fn 6-1107
This rermit coven work to be done on Private Property ONLY -
Any construction on the public domain (curbs, sidewalks, drivOWSYN,
marquees, etc.) wdi require sepamte permission.
z
W
[] YES [3 NO
Valuation I Fee
M-/
APPLICATION APPROVAL
This application Is not a permit until
vigned by the Building official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
FILE
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