710509.pdf1 �
ED ON KROL MAP NO.: PERMIT
•� BUILDING
DEPARTMENT
Applicant Fll1
NUMBER
PERMITAPPLICATION
I
inside Heavy LinesDDRESSNAME
(OR NAME OF BUSINESS)
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SETBACK STREET SETBACK
V
MAI D
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LOT AREA
C T
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1 BUILDING AREA
: A2
yUj ADDRESS
STREET R/W
t4 CITY I TELEPHONE NUMBER EXISTING STREET R/W v
!c COMP. PLAN ST. R/W ..L.�.`.l.:r
or
❑ NEW
®GAS
RESIDENTIAL
LINE
121 ADD
NON-RESIDENTIAL
SIGN
RETAINING
❑
DEMOLISH
�
ALTER
❑
ORFILL
❑
PENCE
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❑ REPAIR
❑
PRE -swim
INSP.
❑
POOL
DWELLING
UNITS
EF—M'g
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 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.)
NOTE: Applicant Subject to Plan Check Tee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curb@, sidewalks, drlvowa76,
marquees, etc.) will require separate permission.
❑ YES
LR YAI
/
YES
DEFICIENCY TIIIS PROPERTY
C�. ..FT.
^RU�OON I STREET IMPROVED
❑ YES ❑ NO
THIS SITE IS LOCATED IN THE
REMARKS CITY OF EDMONDS. LOCAL SALE
TAX SHOULD BE CODED 31.04.
Xu,r li.ju te, PCs3L_ C>%3C / :?.n
Valuation
Plan Check No .....................
BUILDING S�Q
PLUMBING 7
HEAT d: GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Fee
W
r
Receipt No.
rA7=NTION
UNT DUE
APPLICATION APPROVAL
ERMIT This application is not a permit until
RIZES signed by the Building Official or his Dep-
THE ut and fees are paid, and recei t is acNOTED y; p
knowledged in space provided.
INSPECTION DIRECTO SIGN
DEPARTMENT
CITY OF DATE
EDMONDS
PR d-1107
0
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