670012.pdfDEPARTMENT
APPLICATION
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17 9'
Applicant Fill
inside Heavy Lines
57,
3 —7�1 0 CD
FO-STED ON KROLL MAP NO.'. PERMIT
NUMER 670012
12
�013 ADDRESS
3IDE YARD SETBACK
STREET SETBACK
MOM YARD SETBACK
USE ZONE
'VACANT
LOT AREA
IFFE1
13 YES E] NO
HEIGHT
BUILDING ARSA
VARIANCE NUMBER
PLOT PLAN APPROVED
STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT-
REAEARKS
CHECKED BY
3LETER SIZE SERVICE SIZE
RE�S
TYPE CONNECTION
VERIFIED BY
PERMIT NU�ER
PERU. TEST
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 YES C3 NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
El YES 13 NO
GAS
RESIDENTIAL LJNE
El NEW
NON-RESIDEN=J6 SIGN
"V ___ - RETAINING
ElDEMOLISH WALL
ALTER EXCAVATE PENCE
DOR FILL ( ........ . X . ........ Ft.)
PRE -MOVE SWIM
REPAIR F-1 INSP. POOL
RZbLkRHS
77 G I 6-H 7�b
C-o 9ti ir R 6 f? 110.
NUh[BER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
P— V--.'Ct -5 i" 45 f N
Plan Check No .....................
Valuation
Fee
Receipt No.
PROPOSED USE
BUILDING
PLUMMNG
PLOT PLAN (Indicate Building setbacks. abutting streets)
t
HEAT & GA13 LINE
PENCE
SIGN
RETAINING WALL
000
/,9' 0 o
SWIMMING POOL
DE OLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
/0 '.0 Z)
I hereby acknowledge that I have read this application; that the In-
formatlion 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-
I&tlug construction; and In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
nialIng to Workmens Compensation Iwumnft-
NOTE: Permit Limit one Your (Except DE31OLITIONS which
shall be completed In ninety days; MOVED4N BUILDINGS shall be com-
pleted In mix months.)
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
APPLICATION APPROVAL
This application is not a pern-At until
signed by the Building official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
SIGNAT JRE (OWNER OR AGENT)
DATE SIGNED
DIRECT R's
NOTE: Appli"nt Subject to Plan Check Fee
FILE
This rarrult coven work to be done 001 Private Property ONLY.
Any construction on the Public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
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