700559.pdfsill El N KROLL MAP NO.: PERMIT
NUM13ER
BUILDING, DEPARTMENT Applicant Flu
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PM17 J1nsldc'jI:vyFLU1ncs JOIS ADDRESS
PERMIT APPLICATION
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we.—rintion of ProDerty (Show Below or Attach Four i
700559
SIDE YARD SETBACK STREET SETB ACK REAR YARD SET13ACH
;a 5— 1 ?7? *
5_'222 a
USE ZONE T AREAL v A�JAAI , SITE
ij YES _4 0
EXISTING'STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ F-r- ............
REMARKS
BY
F CONSTRUCTION STREET IMPROVED
I I [] YES
Z
NEW RESIDENTIAL
NON-RESIDENTIAL
DEMOLISH
ElALTER EXCAVATE
ElOR FILL
REPAIR PRE -MOVE
INSP.
-R—UMBER 010 STORIES NUMBER OF
DWELLING
UNITS
F�
GAS
LINE
SIGN
RETAINING
WALL
FENCE
( .......... x ..........
SWIM
POOL
Ft.)
[3 YES [3 NO
PLAN CHECKED 13Y
REMARKS
All work to co mply with#the 1970 Uniform
Building Code.
NATU
E OF 0 X TO BE DONE
Plan Check No .....................
Valuation
Fee
Receipt No.
BUILDING
PROPOSED USE
PLOT PLAN (Indicate Building setbacks, abutting streets)
tRETAINING
N
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read thin application; that the In-
formation given Is correct: and that I = the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state laws 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
al'on
or Ih
o duly
8 a 0 b
t th
sUlh
e
In
or
'here y 'Wa r r gu'
b ' no PC son
State of Washington
relating to Workmen's Compensation Insurance.
v
NOTE: Permit Limit One Year (Except DEHOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDII�GS shall be corn-
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE 8 NED
IG
11F722 7
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on privets property ONLY.
Any construction on the public domain (curbs, oldewalkas drivewaYsp
marquees, etc.) will require separate perminalon.
TOTAL AMOUNT DUE
ATTENTION
THIS PER511T
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
I //, o o K,5`9(7
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.
FILE
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