710513.pdfPOSTED ON KROLL MAP NO.:
NUMBER
( 710511
BUILDING
DEPARTMENT
ApplicantFlll
// � (,cJ
PERMIT
APPLICATIONInside
Heavy Lines
JOB ADDREfjS r
NAME
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PHONE
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ADDRESS
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TELEPHONE NUS
NAME _
ADDRESS
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TELEPHONE NUI
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STATE LICENSE NUMBER
I CITY LICENSE N
Legal Description of Property (Show Below or Attach Four Co;
N
y
L .n r, / 9 , / 1
SIDE
YARD
SETBACK
STREET SETBACK
REAR. YARD SETBACK
USE
ZONE
LOT AREA
VACANT SITE
S —
I
I (AYES [] NO
HEIGHT
(BUILDING AREA
IVARIANCE NUMBER
RESIDENTIAL
El
GAS
LINE'NEW
D NON-RESIDENTIAL
❑
SIGN
ADD
❑ DEMOLISH❑
WAILINING
ATE
PENCEX...
ALTER
ElOROFI
❑
Ft.)
REPAIR
PRE-wim
❑ IN
O
.......
POOL
P.
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
/Y.t= /1/- 1/17 VJ C-1�
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 DEDIOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted 1n six months.)
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,
nturquees, etc.) will require separate permission.
PLOT PLAN APPROVED
STREET R/W
EXISTING STREET R/W l�..y . -FT. DEFICIENC�Y++--THIS PROPERTY
COMP. PLAN ST. R/W�7.�...FT. L—'D..FT.
REMARKS
Driveway slopes not to exceed those
indicated on Standard Drawinn 0103
TYPE OF
C] YES 0 NO
STREET IMPROVED
[] YES E] NO
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE
RppEMARKS (� `S—
UASIc.I R TAX SHOULD BE CODED 31.04,
A::I I4�
Plan Check No.
BUILDING
PLUMBING
HEAT d: GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
Valuation I Fee
r
No.
L 3s
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.
DATE /
-i�- 7i.
FILE
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