700391.pdfBUILDING DEPARTMENT I ApplIcant FIU
PERMIT APPLICATION Inside Heavy Lin
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NAME tult-14APIN
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MAILING ADDRESS
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CITY TELEPRON r, NUMIMR
de 1014 0,4JAOS
NAME yjw� 60o2k
7716-Z- 4- 4VAI
�ATE LICENSE NUMBER
2- 23 -C) / - eo*75�5
egal Description of Property (Shc
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or Attach Four Copies)
NEW
RESIDENTIAL
GAS
LINE
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NON-RESIDENTIAL
ADD
SIGN
RETAINING
DEMOLISH
WALL
EXCAVATE
FENCE
ALTER
OR FULL
0
( x Ft.)
REPAIR PRE -MOVE
INSP.
.......... ..........
SWIM.
POOL
NUMBER OF
DWELLING
UNITS
iATURE OF WORK TO 33E DONE
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(�0A.)_S77WC-770^)
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I hereby acknowledge that I have read thin application; that the In.
formation given In correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state lawn regu.
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
relating to Workmen'o Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be eom.
pleted In six months.)
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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.
TED ON KROLL, MAP NO.: PERMIT
/.,;), 0 �0_ I NUMBER 700391
ADDRESS
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SIDE- ID SETBACK
STREET sE;rBACK
BEAR YARD SETBACK
USE ZONE
LOT AREA
VACANT BITE
21 1 '�'
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I vorncs NO
I1EIG1IT
BUILDI
= NG AREA
ARIANCE NUMBER_
I'Lol, A 11 do OVED
ST11 W R/W
EXATITNG STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/1V .4.# .... FT. FT.
REMARKS
Driveway Slopes not to exceed those indicated
on Standard Drawing #103,
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Valuation
Plan Check No .....
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Fee
[] No
to
BUILDING
3
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PLUMBING
HEAT & GAS LINE
FENCE
SIGN
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RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
W�m
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 6-1107
APPLICATION APPROVAL
This application Is not a permit until
signed by Uie Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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