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10STED ON KROLL MAP NO.:
PERMIT
BUILDING
DEPARTMENT
NUM13FM -100075
1
Applicant FlueS I
PERMIT
APPLICATION
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J013 ADDRESS
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ADDRESS
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STATE LICENSE N
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Legal Description of
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Z�NEW
RESIDENTIAL
0
CASE
LIN
ElADD
F1DEMOLISH
0 ALTER
0
REPAIR
M
NON-RESIDENTIAL
SIGN
RETAINING
WALL
PENCE
( .......... x ......... Ft.)
swim
POOL
0
EXCAVATE
OR FILL
PRE -MOVE
INSP.
rUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
N
Z 1
E4 1 PROPOSED USE
PLOT PLAN (Indicate Building setbacks, abutting strects5
C:? 49 - 20q 1�7� LLA"06e- . .64-1101.
tD SETBACK
STREET BET13ACK
REAR YARD SETBACK
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LOW AREA
VACANT SITE
7
06EB 13 NO
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A
n
BUILDING AREA
VARIANCE NUMBER
1,
.1
I. iiT*REET R/W ke.rT. DEFICIENCY THIS PROPERTY
PLAN ST. R/W.4.e..FT. ... 52 .... rr.
indicated on Standard Drawing
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.!3 r_ ".) IF K
3.
-41-1. 1 10 YES PAMO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
0 YES W<O� 1 7— /
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Plan Check No .....................
BUILDING
PLUMBING IS
HE AT & GAS LINE
PENCE
SIGN
tRETAINING
WALL
N
I
SWIMMING POOTP
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowled90 that I have read thin application; that the In-
formation given to 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-
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 rERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE51011TIONS which
[;sshall
ONLY THE
WORK NOTED
be completed In ninety days; BIOVED-IN BUILDINGS shall be com-
pleted In six months.)
TRNXTURff7�lt OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
&g
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquess, etc.) will require separate permission.
5 TE5
Valuation
Fee
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1 &0 1 9g. -ct
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APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or Ws Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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