700106.pdfI
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lin s
NAME (Olt NA51" UP �1.1119�
YUSINJE
- yx
If
A.UVIUN7 rn -,�-
,egal Description of Property (Show I
Q, , � L� LL, - s , Cc L
_�4
W
*0 3
El NEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
SIGN
ADD
WALL
RETAINING
ALTER
DEMOLISH
EXCAVATE
OR FILL
FENCE
( ........ _% .......... Ft.)
REPAIR
PRE -MOVE
INSP.
swim
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITB
F6W_TED ON KROLL MAP NO.: PERMIT
NUMBER -7
1 100106
U13 ADDRE88
S-1 9
IIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK
VACANT SITE Z
USE ZONE LOT AREA
0 YES NO
ty _' CE NUMBER
qEIGHT I nUILDING AREA VARIA 16
F—LOTPLAN APPROVED
STREET R/W
EXISTING STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
ry
........ ... IV.
COMP. PLAN ST. R/W ............ IT- 0
5
REMARKS
Z
HECKED BY
METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
ITE—MARKS
ZONE
[] YES
rian Check No ....................
Z
db4lvt,��
BUILDING
PROPgSED USE j (j
Q
4
PLUMBING
HE, AT & GAS LINE
_FLOT —PLAN (Indicate Bulldl tbarks, abutting streets)
24
0
L1107_�
tRETAINING
N
I
FENCE
SIGN
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I —T--
TOTAL AMOUNT DUE
In
I hereby acknowledge that I have read this application; that the In-
ut h or-
formation given in correct; and that I am the owrer, or the duly author-
r e
Ized agent of the owner. I agree to comply with city and state laws regu.
ATTENTION
5 on
lating construction; and In doing the work authorized thereby, no person
in on
will be employed In violation of the Labor Code of the State of Washington
TIHS PER311T
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Umit One Year (Except DE5101JTIONS which
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com.
pleted in six months.)
ATU DATE SIGNE—]D
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This rermit covers work to be done on private property ONLY.
Any construction on the public domain (curb@. aldewalks, driveways.
marquees, etc.) win require sepamte permission.
[] YES [3 NO
eA
Fee
91 1
No.
1 3-- tll�t
APPLICATION APPROVAL
This application is not a permit until
signed by tile Building Off 1clal or Ms Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE
N
a
0