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BUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME
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MAILING "DRESS
9703 Alyzc ni's Iw
CITY TELEPHONE NUMBER
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W ADDRESS
A/ 00 40R-111"6.%0/v0 ii/O'
CITY TELEPHONE NUMBER
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STATE LICENSE NUMBER CITY LICENSE NUMBER
2-�L3-bi-957�Lir I
Legal Description of Property (Show Below or Attach Four Copies)
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ElPRESIDENTIAL El LINE
NEW
NON-RESIDENTIAL ❑ SIGN
1 /�I ADD RETAINING
T� El D_^,MOLISH WALE'
ALTER EXAVAT❑ OltCFILL E ❑ (ENC x.......... Ft.)
REPAIR ❑ INSPhfOVE swim
POOL
NUMBER OF STORIES NUMBER OF
/ DWELLING
UNITS
NATURE OF WORK TO.�B••E DONE.
,FA-rsN+b A t� !D7lyr-l. NEW T%IN%.vG /LEI}
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G PROPOSED USE
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a PLOT PLAN (Indfcato Building setbacks, abutting streets)
of
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I hereby acknowledge that I have read this application; that the In-
formation given Is correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and elate 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
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEIMOLITIONS which
shall be completed In ninety days; BIOVED-IN BUILDINGS shall be com.
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
P NO.:
C
PERMIT
I NUMBER
..oa141
9
RD SETBACK I STREET SETBACK
c
•'iti k. J �� S I n♦
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
`7 (0039
•REAR YARD SETB
_[s- In i
VACANT SITE
❑ YES -a/NO
DEFICIENCY THIS PROPERTY
.FT. Y
TYPE OF CONSTRUCTION
❑ YES ❑ NO
REMARKS
Plan Check No .....................
BUILDING
f7its)?i1l�Ie
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OIt FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTIIORIZF.S
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
Valuation
ME
❑ YES ❑ NO
Fee
P
wI
1
■
No.
a 3
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-
knowledged in space provided.
1.
-S'_
FILE
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