640456.pdfPOSTED ON KROLL MAP NO-: PERMIT
NUMBER
BUILDING DEPARTMENT Applicant FBI
Inside Heavy Lines JOB ADDRESS
PERMIT APPLICATION nes
R NAME OF BUSINESS) -7 13'
INAME to
�:�_ - )W. SIDE YARD 6INBACI
or
-7
,00087
VACANT SITN
0 YES �No
ow
VARIANCE NURBER
�;7SRrN-0,115'T'REET R/W ............ FT- DEFICIENCY THIS PROPERTY
Co?aP. PLAN ST. R/W ............ FT- ............ 17. 0
REMARKS
i:
I
t."
ERmIT NUMBER
PERC. TEST
REMARKS
0
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
07 4z� 0 YES NO
I I e
I I
_12=
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
YES W40
GAS
RESIDENTIA NE
Ml
CHEWC
NEW
PLAN
TIAL
NON-RESIDE�LN ON
[:] SJ(
f
RETAINING
D WALL
REUAW
0
DEMOLISH
ALTER EXCAVATE FENCE
OR FILL ( ........ . x .......... Ft.)
REPAIR PRE -MOVE SWIM
INSP. POOL
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Valuation Fee
Receipt No.
g&j" r2 ?2e&= J2s==cu%_
Plan Check No ........ . ...........
Z
0
—
BUILDING
2.t
PROPOSED USE
PLUMBING
PLOT PLAN (Indicate Building setbaclo, abutting streets)
HEAT & GAS LINE
0
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
pRE.MOVE INSPECTION
EXCAVATION OR FILL
0
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that the In-
formation given Is correct; and that I am the owmer, or the duly author-
city and state laws regU-
APPLICATION APPROVAL
ized agent of the owner. I agree to comply with
ATTENTION
I&tlng 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
This application Is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZM
signed by the Building official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
be com-
ONLY THE
WORK NOTED
uty; and f ees are paid, and receipt Is ac-
knowledged in space provided.
shall be completed In ninety days; 31OVED-IN BUILDINGS shall
pleted In six months.)
INSPECTION
I C on, SIGNATA;RE
SIGNAT ER OR AGENT)
DAT IGNED
DEPARTMENT
:Z1 -4
13—
CITY OF
,�
EDMONDS
DATE
7i)
V Fee
NOTE: Applicant Subject to Plan Check
PR 4-1147
This Permit covers work to be done onprivate property ONLY.
Any construction on the public domain (curb$, sidewalks, driveways,
FILE
marquees, etc.) will require separate permission.
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