690385.pdf.. .. .. . . . . . .. . .
POSTED ON KROLL
BUILDING DEPARTMENT Applicant Fill
5 PERMIT APPLICATION Inside Heavy Lines jog ADDRESS
7TMENT A FT
Linelm
!ION 11 P P,,l7cc"a7vty
In ldi
NAME (OR NAME OF BUSINESS) 75, pc�) 0 0
SIDE YARD SETIJAI
MAILING ADDRESS'
USE ZONE
HEIGHT
CITY TELEPHONE NUMUZt de9<7
9
'a CL -Y),
W
or ALtacn �o
1 ['0+ (LID
L 4q in-o- P-CL D-) (V AJ d �Z
NEW
1
L�rRESIDENTIJILL
F
GAS
LINE
1:1
NON-RESIDENTIAL
F1
SIGN
ADD
RETAINING
WALL
DEMOLISH
g_`kLTER, EXCAVATE
OR FILL
FENCE
( x Ft.)
.......... ..........
REPAIR PRE -MOVE
INSP.
swim
POOL
4UMr�ER OF STORIES
NUMBER OF
DWELLING
UNITS
IATUREI OF WORK TO 13B DONE
T I - t I/^ - I __
P NO.:
PERMIT
I NUMBER
VACANT SITE
A
0 YES 13 NO Z
VARIANCE NUMBER 04
PLOT PLAN APPROVED
X4,
STREET R/W A.
EXISTING STREET R/W ........... X"T. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT.
REMARKS
CHECKED By
0 YES
Ll L
Plan Check No .....................
W1,
BUILDING
PLUM13ING
setbacks, abutting streets)
HEAT & GAS LINE
PENCE
SIGN
I
tRETAINING
WALL
N
SWIMMNG 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 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 lawn 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 Workmen'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 six months.)
1IGNATURE (OWRIETROR AGE T) DATE SIGNED INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
-This permit covers work to be done on private PmPDX17 ONLY.
Any construction on the pubtlo domain (Curb#, oldewsAs, driveways.
numquws, etc.) wHi require sePamte Permission.
Valuation
0 YES doN�o
Fee
No.
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are vaid, nnd rece!pt is ac-
Imowledged In Space provided.
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FILE
N - - -
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