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710482.pdf
1 BUILDING DEPARTMENT I Applicant Fill PERMIT APPLICATION Inside heavy Lines NW (OR NAME OF 1NESS) e,-; (/ MA NO ADDRESS i mV.r.FPF4nNF NUMBER 111 ^' / h'/ U111% },) ADDRESS C CITY �j e- PERMIT NUMBER IETBACK I STREET SETBACK REAR YARD t YES 13 NO Q TELEPHONE NUMBER EXISTING STREET R/W .,`.r.FT. DEFICIENCYTHIS PROPERTY COMP. PLAN ST. R/W 6-ta..FT. /0....I TT. iC. REMARKS Driveway slopes not to exceed those ADDRESS/ G 04 CITY TELEPHONE NUMB STATE LICENSE NU1t li I CITY LICENSE NUD Leea1 Descr1Dtlon of Property (Show Below or Attach Four Cople s'ew U %e4o s', RESIDENTIAL El AS LINE © NEW NON-RESIDENTIAL ❑ SIGN ❑ ADD RETAINING WALL DEMOLISH FENCE ALTER 1_1 E] Ft.) ORFILLEXCAVATE .x.......... REPAIR PRE -swim ❑ IN P. 1 1 LL__FF POOL NUMBER OF STORIES NUMBER OF 7 DWELLING UNITE �% �, ,.`//.� %e NATURE OF WORK TO BE DONE Ac_!w / u -o CL ffp ,Vt C . PROPOSED USE A W O PLOT PLAN (Indicate Building setbacks, abutting streets) A t I 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: BIOVED-IN BUILDINGS shall be eom. pleted In six months.) GTE: Ap It ant SuGjeet to Plan Cb _ 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. � 6r 50PPCY Pam- ("C to -z v CONNECTION / VERIFIED BY fries, L f L7 1 Ste/ IH%� FIRE ❑ YES ❑ NO i] YES PLAN CRECKNIJ I:Y THIS SITE IS LOCATED IN THE CITY OF EDMONDS. LOCAL SALES REMARKS TAX SHOULD BE CODED 31.04. I -Ian Check No BUILDING PLUMBING ! HEAT & GAS LINE FENCE SIGN RETAINING WALL SWIMMING POOL DEMOLITION PRE -MOVE INSPECTION EXCAVATION OR FILL TOTAL AMOUNT DUE ATTENTION THIS PERMIT AUTIIORIZES ONLY THE WORK NOTED INSPECTION DEPARTMENT CITY OF EDMONDS PR 0-1107 No. s 0 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. 9 i i I i 1 t i