710539.pdft
POSTED ON KROL MAP NO.: PERMIT 5 �9
� BUILDING DEPARTMENT AnrucantP'iu
NUMBER I U�IJ
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
: NAMI& (OR NAME OF ➢UMNESS) '4/ L, ..-./ U ��,P�' . S • (_t--) '
14
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BIDE YARD SETBACK I STREET SETBACK I REAR YARD SETIIACI(
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USE ZONE LOT AREA VACANT BITE
/ `S (/ • - O I I OE8 (] NO
BTILEEW nI W j�r7
EXISTING STREET R/W Ij/.�.S/Z�FT. DEFICIENCY THIS
T�THIS PROPERTY
COMP. PLAN ST. R/W :G.lo...FT. ....t...l...FT.
REMARKeDI.ivei-)ay slopes not to exceed those
indicated on Standard D(vs. sit• 103.
ISE NUMBERCITY LICENSE NUMBER
_O ` _j1�.Q 1 i�Y 1 % I REM; K8 /. ��
ton or Property (Show Below or Attach Four Copies) (z �� `)
_
TYPE CO NECTIO I Vi
NEW
RESIDENTIAL
I R
13
OAS
LINE
NON-RESIDENTIAL
❑
SIGN
ElADD
RETAINING
WALL
ALTER
❑
DEMOLISH
OROFILLTE
❑
CE
FEN.. xFt.)
REPAIR
�j
I `
PRE -MOVE
INSP.
j�
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..........
SWIM
POOL
DWELLING
UNITS
0
1
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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 DRMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on thepublicdomain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permleelon.
FIRE ZONE TYPE OF C STRU ION STREET IMPROVED
`—' _�I YES ❑ NO
SPECIAL INSPECTOR REQUIRED OCCUPANy'Y O OUP
YES �NO 3 I
PLAN CHECKED BY 111
THIS SITE IS LOCATED IN THE
REMARKS
CIT.-Y OF €BAIE)NDS. LeeftL ALES
TAX SHOULD 13E�CODED 31.04.
t00"IT"%(c4c T6 ko\ s
Valuation I Fee
Plan Check No .....................
BUILDING y
PLUMBING % ' l/
HEAT do OA``I LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
t�
TOTAL AMOUNT DUE I I /Z O' 00 0 3-$4
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION DIRECTOR'13,SIGNA.TURE
DEPARTMENT
CITY OF
EDMONDS DATE
PR 0-1107
FILE
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Date Passed
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Drainage
Sewer
Parking —
Landscaping
Fire Dept.
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