710211.pdfPOSTED ON KROL
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION I Inside Heavy Lines JUB ADDRESS
NAME (OR NAME OF BUSINESS) 211.12-212 S . W .
Russ Baltzell SIDE YARD SETBACK I aT
3
0
2410 N.E. 1
Seattle. Wn
Advance Plumbing & Heating Inc
ADDRESS
1209 N. E. 125th St
CITY TELEPHONE NUMBER
Seattle, Wn I EM 4-1960
NEW
RESIDENTIAL
R
GAS
LINE
NON-RESIDENTIAL
SIGN
QADD
Q
DEMOLISH
Q
RETAINING
WALL
QALTER
Q
OROIA+•IVLALTE
Q
Y'ENC.z_Ft.)
Q REPAIR
ElINSP.
PRE -MOVE
Q
........
swim
POOL
IUMIIER OF STORIES
NUMBER OF
DWELLING
UNITS
5
7'h or .
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
YES ❑ NO
Plan Check No .....................
BUILDING
PLUMBING
HEAT A OAS LINE
FENCE
SIGN
tRETAINING WALL
I
SWIMMING POOL
DEMOLITION
PIE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin 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 lawn regu-
ATTENTION
lating coantruction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
HE
ONLY WORWORKNOTEOTT D
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
G ATURE (OWN OR AGENT) DATE SIGNED
INSPECTION
t�
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
_
rn 6-II07
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) win require nepamte Dermisslen.
PERMIT 710211
NUMBER
IACIC I REAR YARD SETBACK
VACANT SITE yL-1
❑ YES ❑ NO fjS
:EA I VARIANCE NUMBER G.
DEFICIENCY THIS PROPERTY
❑ YES ❑ NO
Valuation I Fee
C
zo
W
r.
4
No.
1 47.5-01 (eos3
APPLICATION APPROVAL
This application is not a permit until
sighed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
DATE
FH.E
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1
1
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