690327.pdfAuk
IN KROLL MAP NO.: PERMIT
MENT Applicant Fin I NUM13ER 690327
[ION Insido Heavy Lines J013 ADORE -IC4 � I
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V X C;� _!� - � 0 Ud
EDE SETBACK
STREET SETBACK
REAR YARD SET13ACK
PRO
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-2� 1 r-y\ A-.
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LOT AREA
4
81TE
IVACANT
0 YES
LEIGHT
I BUILDING AREA
1 VARIANCE /NUAlBFR
/4/0 (5 /-1 CL� 7--k
STREET R/W E/
,EPHONE NUMBER EXISTING STREET R/W ............ FT.
I COMP. PLAN ST. R/W ........... X-T.
- �;, Ytps -
RESIDENTIAL
F�
GAS
LINE
NEW
E]
NON-RESIDENTIAL
SIGN
ADD
F]
RETAINING
WALL
DEMOLISH
EXCAVATE
FENCE
ALTER
F1
OR 117LL
X Ft.)
L& REPAIR
PRE -MOVE
INSP.
.......... ..........
SWIM
POOL
NUMBER OF
DWELLING
UNITS
FIRE
0 YES
[] NO
CONSTRUCTION
THIS PROPERTY
STREET IMPROV]
0 Ylus IJ NO
REMARKS
Permit issued subject to field inspections.
!�P7" Q / ec 1—flE w YJ �/r�
Plan Check No .....................
'a
BUILDING
PROPOSED
PLUMBING
PLOT PLAN (Indicate Building setbaeks, abutting streets)
N
HEAT & GAS LINE
FENCE
SIGN
I
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I havo read this application; that the In.
'h In'
t�
formation given is correct; and that I am the owner, or the duly author-
'y M or-
laws regu-
izcd 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
no person
Washington
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
I
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORIE NOTED
shall be completed In ninety days: MOVED -IN BUILDINGS shall be com.
Pleted In six months.)
NATURE (OWNE11-011, GENT)
DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
id�
EDMONDS
NOTE: �Ippficant 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 (curbs, sidewalks, driveways,
marquees, etc.) will require separate Permission.
Valuation
uo 1 �2 Z 0, —0
rZ
No.
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.
1 4