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POSTED ON KROLL MAP NO.: PERMIT
NUMBER 700556
BUILDING DEPART ENT A it Trill I I
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PERMIT APPLICATION Inside Heavy Lines
NAME 101rTq7C=M-0 81"N"-
1/f � s
MAI t 14C e— G 0 SP CZ2
LIV ADDRESS
L 9 ? 16) 1 -g ct)
(Show Below or
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rHACK
REAR YARD SETBACK
VACANT 131TE
0 YE13 0 NO
Z
LRBA
VARIANChl NUM1,59-1t
EXISTING -STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT.
REMARKS
I] YES [] No
E )E TIA GAS
SII: N L
0 YES (:] NO
LINE
NEW
PLAN CHECKED BY
_ NON-RESIDENTIAL El SIGN
F] L
ADD ..j
RETAINING
ElDEMOLISH ED WALL
REMARKS
0 ALTER EXCAVATE FENCE
E] OR FILL ( .......... x .......... Ft.)
REPAIR PRE -MOVE SWIM
1:1
INSP. POOL
NUMBER OF 13TORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO 13E DONE
Valuation
Fee
Receipt No.
S-0
I -Ian Check No .....................
BUILDING
PROPOSED USE
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
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.
5— 'T
formation given In correct; and that I am the owner, or the duly author-
Ized agent of the ov6mer. 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 Insurance.
AUTHORIZES
eigned by the Building Official or his Dep-
NOM Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
uty; and fees are paid, and receipt Is ac-
s)&I be ompleted ninety days: MOVED -IN BUILDINGS shall be eom-
As
knowledged in space provided.
ftlete ;� six man -
ION URE -410,WN] OR AGENT) DATE 81GNED
?Ift
INSPECTION
SIGNATURE
P
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PH 0-1107
sz�
This Permit covers vrork to be done on private property ONLY.
118
Any construction on the public domain (curb , sidewalks, driveways,
require
FILE
marqueen, etc.) will separate permission.
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Pgoo0i OF INSPECTtONSJ
Date Passed
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fir "Wn
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Fri ffal
'PECORD OF INSPEGTIONS
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Date Passed
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