710504.pdft„ BUILDING Dti'AK1flfitlil1
PERMIT APPLICATION
NAME (OR NAME OF BUBINi6813)
pe 1 M
MAILIN ADDREBB
X O C1T�Y72,:�S 2_ Z C TF
�1 N�oNDS 9�ozol
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or
I'08TED ON KROLL MAP NO.: PERMIT _
Applicant Fill I NUMBER 11050'. r _
Inside Heavy Linos joB ADDRESS
P7 n -3 - a i�L C—,- . I i
77 8 -s'B S� I
NEW
RESIDENTIAL
AS
LINE
❑
NON-RESIDENTIAL
❑
SIGN
ADD
KING
❑
DEMOLISH
❑
WALL
TE
PENCE
ALTER
❑
ORCFIL
❑
x......... Pt.)
REPAIR
10
El
PRE -MOVE
INSP.
SWIM
POOL
/ I DWELLING
UNITS
EXTCQb
O L
1
N
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 ComDensatlon Insurance.
DOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days, MOVED -IN BUILDINGS shall be com-
p1pttAin six months ih
u4et-wro liz Oc r 71
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 separnte permission.
BIDE DE BETBACKI
STREET SETBACK I
REAR YARD SETBACK
USE ZONE
C
I LOT AREA I
VACANT BITE /
❑ YES O
EIEIGHT
i IIUILDIN6 AREA
I VARIANC NU R
PLOT PLAN APF RUVl u
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN 8T. R/W ............FT. ............FT.
FIR TYPE OF C2UTRUCTION I STREET❑ IMPROVED
YES No
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUJL�.
❑ YES [)CVO I ', J -- I
PLAN CHECKED BY THIS SITE IS LOCATED IN THE
CITY OF Fnnann 1 DS nnni SALES
REMARKS TAX SHOULD BE CODED 31.04.
W JTsA
Finn Check No.........
BUILDING
PLUMBING
HEAT A OAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Valuation I Fee
e
KAI
No.
TOTAL AMOUNT DUE I I 7� I , K,6 � Sp\
ATTENTION APPLICATION APPROVAL
THUS PERMIT This application Is not a permit until
AUTDORIZE8 signed by the Building Official or his Dep-
ONLY THE
WORM NOTED uty; and fees are paid, and receipt is ac-
1 nowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR d-1107
ifs-l2-
FILE
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