710332.pdft
C. C
I
BUILDING DEPARTMENT
PERMIT APPLICATION
Applltannt Fill
Inside Heavy Lines
POSTED ON KROLL MAP NO.;
PERMIT
NUMBER
J08 ADDRESS n
l/,s 2 -- / � -say '
NAME (OR NAME OF BUSINESS)
/ i� l ��
BIDE YARD SETBACKI STREET SETBACK
LINO AD 8
C ,
O+TELEPHONE
USE ZONE LOT AREA
7rS —
C
NUMBER
/
OIL '`Y iA�w ��' ['t `7� �9a,/
HEIGHT I BUILDING AREA
G ADDRESS
CITY TELEI
!!! NAME
i
sI AWDRESS
ee
m CITY
. TELE
or
710332
13 YES 13 NO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
O
PERC. TEST
WREMARKS
Q
(�
FIRE ZONE I TYPE OF
SPECIAL INSPECTOR REi
❑ YES NO
OAS
NEW RESIDENTIAL ❑ LINE
NON-RESIDENTIAL ❑ SIGN
❑ ADD ❑ RETAINING
DEMOLISH
ALTER EXCAVATE
OR FILL ❑ FENC.x.......... Ft.)
PLAN CHECKED BY
REMARKS
REPAIR INSPM0�swim POOL
NUMBER OF STORIES NUMBER OF -�
DWELLING
UNITS
N URE OF W RK TO BE NE
Plan Check No .....................
BUILDING
0
��i,
p
O/ OO o
PROPOBED USE
PLUMBING
c?�(
Q
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAB LINE
22
FENCE
SIGN
tRETAINING
WALL
iSWIMMING
POOL
DEMOLITION
PRE -MOVE INSPECTION
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-
ized agent of the owner. I agree to comply with city and state Taws regu-
lating construction; and In doing the work authorized thereby, no person
ATTENTION
will be employed In violation of the Labor Code of the State of Washington
TIUS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit - !t One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
sh complete a sty days; MOVED -IN BUILDINGS shall be com-
ted7in six m ths.
ION TURE WINR OR AGENT) DATE ION D
� '
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PH 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domaln (curbs, sidewalks, drlveways,
marquees, ate.) will require separate permission.
YES ❑ NO
I l ns SITE IS LOCATED IN
CITY OF EDMONDS. LOCAL
HOULD BE CODED 3
Valuation I Fee
APPLICATION APPROVAL
No.
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.
FILE
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