690395.pdfED ON KRO" MAP NO-; PERMIT
BUILDING DEMIMEN1 Applicant Fill I NUMBER 690395
PERMIT APPLICATION Inside Heavy Lino" JOB ADDIIIII13
NAME (OR NAME OF BUSINESS)
X--7 C--w aI_Q�
UAILINGLAWRNdd
CITY
TEL
NAME
W
ADDRESS
CITY
TE!
or AUMC11
1 7
I
N
GAS
NEW JZ3�RESIDENTIAL LINE;
1 1:1 NON-RESIDENTIAL SIGN
ED-ADD RETAINING
ElDEMOLISH WALL
ALTER EXCAVATE PENCE
D OR FILL ( ........ . x .......... Ft.)
E] REPAIR PRE -MOVE SWIM
INSP. POOL
NUM13ER OF STORIES
NUMBER OF
DWELLING
UNITS
A
1142 - N'O-c4r- V
LRD SETBACK STRI;Wr 23NT13ACK REAR YARD SETBACK
0
Z
INE LOT AREA VACANT SITE
0 YES NO
9 - n I
DING AREA I VARIANCE NUMBER a,
PLOT PLAN APPROVED
STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COXF. PLAN ST. R/W ............ FT . . . .......... FT.
REMARKS
[3 YES [j NO
:0 - -
Plan Check No .........
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING
WALL
N
SWIMMING 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.
M
lzed agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
luting 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 Insuranoe.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
I
shall be completed In ninety days; MOVED -IN BUILDINGS shall be oom.
pleted In six months.)
3IGNATURE (OWINNIt Ult Au�"A)
D,5,Tp SIGNED
INSPECTION
I
DEPARTMENT
"�&"
ff/� Iq
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
rR 6.1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
[3 YES [3 NO
Valuation
N
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-
Imowledged in space provided.
0-01-6,
FILE
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Foundation
Pluml�ing (Partial)
(Rough) Z �0
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.... ...... Frame
Furnace & Fuel 07114
Lines
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