690366.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
POSTED
Applicilint Fin
inside Heavy Lines JOB
ON KROLL MAP NO.: PERMIT
NUMBER 690366
ADDRESS
C2 / ��o q �
NAME (OR NAME OF BUSINESS)
SIDE
YARD SETBACK
STREET SETBACK REAR YARD SETBAUn
MA
USE
ZONE
LOT AREA VAUALM'17 HKEN
[3 YES C] NO
I TELEPHONE NUMBER
HEIGHT
BUILDING AREA VARIANCE NUMBER
NAME
PLOT
PLAN APPROVED
W
ADDRESS
STREET
EXISTING
n/W
STRE= R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ... ....... FT.
CITY
TELEPHONE NUMBER
-REM—ARKS
NAME
ADDRESS If
CkLEUKNI) BY
CITY lip
TELEPHONE NUMBER
METER SIZE
13ERVICE SIZE CLEARANCE
CHECKED BY
ISTATE LICENSE NUMBER CITY LICENSE NuhiHiutt
REMARKS
I Legal Description of Property (Show Below or Attach Four Copies)
[3 YES [3 PTO
EaNEW
F1ADD
ALTER
REPAIR
EynEsrDENTIAL
1 1:1 NON-RESIDENTIAL
DEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
INSP.
Li
CA
LINSE
SIGN
RETAINING
WALL
PENCE
. ....... 17t.)
swim
POOL
I
0 YES [I NO
PLAN CHECKED BY
REMARKS
?[ZE5S-ug,(�
VJ1.r4 vwc
JQCU\Jt?M
11,_1 75-T�
NUMBER OF
DWELLING
UNITS
I
�A_T,'MM OF —WORK TO BE DONE
I
Valuation
roe
Receipt No.
t
N
I
I hereby acknowledge that I have read this application; that the In-
formaUon given Is 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-
I&Ung construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workman's Compensation InBuranoe.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six Months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private Property ONLY.
Any construction on the pubtlo domain (curb@, sidewalks, drivewaya,
marquees, etc.) will require sep�te permission.
Plan Check No ........
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
UTOTAL A31OUNT DUE I
W"Q_V_RW�l .1
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
.00
APPLICATION APPROVAL
Thin application Is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
Imowledged in space provided.
— 2�q ,
I
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