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BUILDING DEPARTMENT I ApplicantR11
PERMIT APPLICATION Inside Heavy Lines
ADDRESS
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TELEPHONE NUMBER
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JN KROLL MAP NO.:
PERMIT
710187NUMBER
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LESS
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RD SETBACKI'STREET
SETBACK
REAR YARD BETHACH
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LOT AREA
VACANT SITE
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YES ❑ NO
KISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
FIRE ZONE
NEW
RESIDENTIAL
"
LINE
❑ YES ❑ NO
PLAN CHECKED BY
111
ADD
ALTER
REPAIR
❑ NON-RESIDENTIAL
DEMOLISH
❑❑
EXCAVATE
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❑
PRE -MOVE
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❑
SIGN
RETAINING
PENCE
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swim
POOL
REMARKS 1
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DEFICIENCY THIS PROPERTY
I��IfiC�]
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Plan Check No ........ ............
Valuation
Fee
Receipt No.
'
BUILDING
PROPOSED USE
PLUMBING
A _ o�
PLOT PLAN (Indicate Building setbacks, abutting streets)
tRETAINING
N
ISWIMMING
HEAT & GAS LINE
FENCE
SIGN
WALL
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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 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
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
7
NOTE: Applicant Subject to Plan Check Fee
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.
TOTAL AMOUNT DUE
010
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
AUTHORIZES
THE
ORB
WORK NOTED
This application is not a pernilt until
signed by the Building Official or his Dep-
s are paid, anreceipt uty; and feed is ac-
Imowledged in space provided.
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INSPECTION DEPARTMENTDI TOR'S fQNAT `
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EDMONDS DATE
PR 6-1107 •'
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