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{ POSTED ON KROLL MAP NO,: I PERMIT
BUILDING DEPART M ENT Applicant Fill NUMBER
PERMIT rAPPLICATION Inside Heavy Lines JOB ADDRESS
:(OR NAMS OF BUSINESS) l / / ? 0 V` e
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r111:SIDE YARD f�BETHACK BTRE ETHAOK
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•�� UBID ZONE LOT AREA
..... T PBOND Q QBbii:�R Kn S — / n
�`) • � S S y v HEIGHT
BUILDING
I DI G AREA
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DENSE NUMBER CITY LICENSE NUMBER
!.. q;DesrrlDtlon of Property (Show Below or Attach Four Copies)
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RESIDENTIAL ❑ GAS
LINE
❑ NEW
❑ NON-RESIDENTIAL ❑ SIGN
ADD ❑RETAINING
DEMOLISH ❑ WALL
❑ ALTER EXCAVATE FENCE
❑ OR FILL ❑ (.._......z.......... FL)
❑ REPAIR ❑ PRE -MOVE ❑ POOL
NUMBER OF HTORiEB I NUMBER E UNITS
i
720295
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t YARD @ETD/
� AIoomi
YES Q NO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST, R/W ............FT. ............FT•
REMARXB
lariveway slopes not to exceed those
FXMO
ra.nq unruacn:u rsx THIS SITE IS LOCATED IN IHL
CITY OF EDMONDS. I.00.00. SALES
REMARKS TAX SHOULD BE CODED 31. ,
Si// e0WZF- X 64C r/oX/ &B e$:, /9741
.SaAT[56r TD ON' J"17'4:w
Plan Check No, ........
...... ...
z
I
BUILDING
PROPOSED USE
PLUMBING
Ci PLOT PLAN (Indicate Building setbacks, abutting streets) BEAT k GAS LINE
D
n FENCE
SIGN
VTRETAINING WALL
SWIMMING POOL
Qu I ^ Q �{ DEMOLITION
/feW tara9e 1 G PRE -MOVE INSPECTION
T EXCAVATION OR FILL
TOTAL AMOUNT DUE
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-
lzed agent of the owner. I agree to Comply with city and state laws regu- ATTENTION
Iating construction; and In doing the work authorized thereby, no person
Will be employed In violation of the Labor Code of the State of Washington THIS PERMIT
relating to Workmen's Compensation Insurance, AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
&hall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
81GNA RE (OWNER OR AO NII) DATE SIGNED INSPECTION
DEPARTMENT
/ CITY OF
EDMONDS
NOTE: Applicant Subject to Flan Check Fee
PR M1107
•\ This Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, eldewaau, driveways,
marquees, etc.) will require separate perWsaloo,
!L
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or hie Depe
uty; and fees are paid, and receipt is ac.,
knowledged in space provided.
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