700546.pdfBUILI)MG DEPARTME
PERMIT APPLICATION
NAME
MAILING ADDRESS
AW3 0 62
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Z3�-61�-Xz
Applicant FiU
inside Heavy Lines
41r - P?
CITY ?�TENSE NuMi
or Attach Four Copies)
/ 7 - 77-
NEW
RESIDENTIAL
I
R
GAS
LINE
NON-RESIDENTIAL 10
SIGN
RETAINING
F1DEMOLISH
F1
WALL
ALTER
El
EXCAVATE
OR FILL
FENCE
( x rt.)
.......... ..........
E]
REPAIR
PRE -MOVE
INSP.
El
SWIM
POOL
4UMBER OF STORIES
NUISIDER OF
DWELLING
UNITS
PROPOSED USE
PLOT PLAN (Indicato"T'uIlding se
POSTED ON KROLL Up.: PERMIT
/ NUMBER 10 700546
r0—HADDRESS
SIDE rARD SETBACK STREET SETBACK RFAR YARD SETBACK
/0 m ;n - C2!so 'hfiAl IC26, MiAl - 0
USE ZONE LOT AREA VACANT SITE
PsYES [3 NO
HEIGHT I ISUILDING AREA I VARIANCN NUMBER
EXISTING'STREET R/W - (OU..FT. DEFICIENCY THIS PROPER -JOY
COMP. PLAN ST. R/W 6-
... t! ... FT.
REMARKS
Oriveway slopes not to exceed thosta indicated
Standard Drawing #103.
It
U-1-r-
TYPE
C] YES -M NO
Plan Check No .....................
BUILDING
PLUMBING
1 9 streets) HEAT & GAS LINE
tir
PENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
I EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that the In-
formation given to correct; and that I axn the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws regu- ATTE, NTION
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of WaehIngton THIS PERMIT
that The
U'y out
laws rc
no pc
h
In
or
gu
r3on
r W"htngton
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY TILE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall jbecom-
pleted In six months.)
81 NJ,
e _D INSPECTION
31GN,Vrj�R -3 ER Oft A T) DATE SIG
(OWN]
�0 DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plats Check Fee FR B-1107
This remit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation
:YSDJ
BY
C] YES
Fee
No.
f 1 1/1 a,", I er, 16"% rs
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.
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RECORD OF INSPECTIONS
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