680198.pdfr
BUILDING DEPARTMEN
PERMIT APPLICATION
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POSTED ON KROLL MAP NO.: PERMIT ��� �]�
71HEIGHT
NUMBER 7JJOB ADDRESS
OZ3v—�114BIDE YARD SETBACKSTREET SETHAOK REAR YARD BETBA
W66TLS O LOT AREA VACANT SITE
T.g�,PRO E (7YES10
YU_ BUILDING AREA VARIANCE MBEB
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RESIDENTIAL LINE
❑ NEW NON-RESIDENTIAL ❑ SIGN
ADD DEMOLISH � WNr6
ALTER ❑ ORFILL EXCAVATE K 4.r.�,Ft.)
-REPAIR ❑ NP3SOVE BOIL
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I hereby acknowledge that I have read this application; that the In-
formation given 1s 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 oQm-
pleted in 116 months.) _ 1
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NOTE "Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any coal on the pnbae domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permlsslca.
EXISTING STREET R/W ......._..FT.
COMP. PLAN ST, R/W ...........FT.
■
DEFICIENCY THIS PROPERTY
...........FT.
Valuation I Fee
Plan Check No...._.._.._.._...
BUILDING r
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No.
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SWIMMING POOL
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EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
Es
ONLY THE
signed by the Building Official or his Dep-
NLY
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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INSPECTION DIRECCC}}}'''OR'S BIGNA '
DEPARTMENT i 1'
CITY OF
EDMONDS DA
PR 6-1101
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