710553.pdfI
i POSTED ON KROL MAP NO.: PERMIT
BUILDING DEPARTMENT Appllcallt Fill NUMBER
` PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
NAME (OR NAME OF BUSINESS) 7S 33
a� E C - C-0 1 �' SIDE YARD SETBACK 81
�L{ MAILING ADDRESS
l
Y --� 10 I //'� -• // 1 V Lo .- Ji 1� USE ZONE I Li
W ADDRESS
STREET B/W
CITY I TELEPHONE NUMBER
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
a
U
k
O W
or
NEW
RESIDENTIAL
�
GAS
LINE
NON-RESIDENTIAL
❑
SIGN
ADD
DEMOLISH
RETAINING
WALL
FENCE
ALTER
❑
ORFILL
❑
.x..........Ft.)
REPAIR
INS
POOL
OOL
DWELLING
UNITS
S
C
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 DEMOLITION8 which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
_(C
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, drlveways,
marquees, etc.) will require separate permission.
FIRE ZONE I TYPE OF
C] YES ❑ NO
S. a)-
O YES Q NO
DEFICIENCY THIS PROPERTY
............FT.
❑ YES NO
THIS SITE IS LOCATED IN THE
REMARKS 01*% .
TAX SHOULD EE CODED 31.04.
Plan Check No ....................
BUILDING
4atfat J.c
HEAT d: GAS LINE
FENCE
SIGN
RETAINING WALL
A1.4f't 7 olut:l-p}0
47:P; a RIJOCIR-1
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
TIDE PERMIT
AUTHORIZES
ONLY THE
WORE NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR E-1107
Valuation I Fee
No.
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.
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