710492.pdfPOSTED ON KROLL MAP NO.: I PERMIT
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BUILDING
DEPARTMENT
Applicant Fill
(
PERMIT
APPLICATION
Inside IIeavy Lines
JOB ADDRESS
NAME (OR NAME OF BUSINESS)
S �O 9 �O� ��`�S / t
, •
_ 1 ,i
i i l
SIDE YARD SETBACK STREET SETBACK I RE
YARD BETBACR
f
4
IDS D
: LINO ADRESS ✓ 0
OQ y ^? y ^ 0 � , C ' It L � USE ZONE LOT AREA VACANT SITE
CITY V OG TELEPVHONN NUMB E;R � $ I I 0 YES 4 NO Z
7 S HEIGHT I BUILDING AREA I VARIANCE MBER y
NAME
PLOT PLAN APPROVED
ADDRESS
STREET R/W
Op� EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
CITY TELEPHONE NUMBER
c COMP. PLAN ST. R/W ............FT. ............FT. d
IIEMARISS
NAME
�!�C.�np h o
R7 ADDRESS aza
t0j CHECKED BY
r CITY I TELEPHONE NUMBER
O •• -^^• METER SIZE I SERVICE SIZE I CLEARANCE I CHECKED BY I
E
S,!F-
/ A.
or
E
RESIDENTIAL
GAS
LINE
NEW
NON-RESIDENTIAL
❑
SIGN
ADD
RETAINING
❑
❑
WALLOR
I❑CI
1 I`4
ALTER
DEMOLISH
EXCAVATE
`-F❑'
El
FILL
F
(ENC x
Ft.)
REPAIR ❑
INSP.
..........
p OL
IUMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
r
?A Z
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 Slate of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN IIUILDINGS shall be com-
pleted 1n six months.)
HGN URE (OWNER OR AGENT) DATE SIGNED
4 4pr I io-t/-71
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be dune on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission. '
YES 0 NO
❑ YES 0 NO
CITY OF EDMONDS. LOCAL
Valuation
I'Isn Check No .....................
BUILDING
PLUMBING
HEAT k GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Fee
5-0
TOTAL AMOUNT DUE
I
13 S
J [%
�J
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY TIEE
WORK NOTED
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
DIRT' 'OR'8 8 ATU '
DEPARTMENT
CITY OF
DATE
EDMONDS
7
/ — — / .•.
_ PR 0-II07
FILE
I