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POSTED ON KROLL MAP NO.:
PERMIT
NUMBER
BUILDING DEPARTMENT Applicant Fill 100100
Inside Heavy Line.,; JOB ADDRESS
PERMIT APPLICATION
811113 YARD SETBAOX STREET SETBACK REAR YARD SETBACK
NAME (OR NAME OF BUSINESS)
NAME
41 ADDRI
CITY
NA.ME
— S,
or
5� -
USE ZONE LOT A.REA VACANT SITE
YES NO
HEIGHT I BUILDING AREA. I VARIANCE NUMBER 9W
EXISTING STREET R/W ............ FT
COMP. PLAN ST. R/W ............ FT
10N
DEFICIENCY THIS PROPERTY
............ IV.
STREET IMPROVED
[] YES r] NO
GAS YES [3 NO
RESIDENTIAL
E] NEW IAL LINE PLAN CHECKED BY
E] NON-RESIDENT SIGN
E] DEMOLISH RETAINING REMARKS
ALTER EXCAVATE WAIS 3 C) Lt
FENCE
OR FILL ......... �x .......... Ft.)
REPAIR PRE -MOVE r-.—L_SWIM
1:1 INSP. Lin POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE Valuation Fee —Receipt No.
Plan Check No ..................... j
BUILDING
PROPOSED USE PLUMBING
U
_FLOT —PLAN (Indicate Building set
backs, abutting atreets) 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-
ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION APPLICATION APPROVAL
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 TIHS PERMIT This application is not a permit until
relating to Workmen's Compensation Infiuranca. AUTHORIZES his Dep-
ONLY THE signed bY the Building Official or
.Ndtg: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
ahal' Core "ate" !n ninety days; MOVED -IN BUILDINGS shall be com. knowledged in space provided.
pllted�'J'in sixim,
SIGNATURE 15W OR AGENT) —DATE SIGNEI3 INSPECTION
DIRECTOR's SIGN&TURE
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This Permit coven work to be done an private property ONLY.
Any construction an the public domain (curbs, sidawalksp drlvvw&Ynt FILE
marquees, ate.) will require separate pernalmalon.
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