670022.pdfCA
POSTED ON KROLL MAP NO.: PERMIT
NUMBER 670022
BUILDING DEPARTMENT
Applicant Fill
PERMIT APPLICATION
Inside Heavy Lines
a 0
BUSINESS)
NAME (OR NAME OF
WASMo4r&
SIDE YARD SETBACK STREET SETBACI ARD
USE ZONE LOT AREA V VA� K SITE
j
MAILING ADDRESS
.iv7o,
A* V0 slto A
I [3 YES NO
CITY
wz"EFRONE NUMBER
40 Ail .0
HEIGHT BUILDING AREA 7NCE NUMBER
NAME
PLOT PLAN APPROVED
ADDRESS
STREET R/W
EXISTING STREET R/W ........... FT. DEFICIENCY THIS PROPERTY
CITY TELEPHONE NUMBEF--
COMP. PLAN ST. R/W ............ Fr. ....... .... 1".
REMARKS
NAME
A)
HECKED BY Z
ADDRESS
METER SIZE SERVICE SIZE CLEARANCE CHECKED 13Y q
i
CITY
Kz�rnvasl NUMBER
114
REMARKS
_§TATE LICENSE NUMBER
CITY LICENSE NUMBER
TYPE CONNECTION VERIFIED BY
Legal I Description of Property (Show Below or Attach Four Copies)
PERO. TEST PERMIT NUMBER
REMARKS
FIRE ZONE TYrE OF CONSTRUCTION STREET IMPROVED
1 [3 YES E3 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
[3 YES 0 NO
PLAN CHECKED BY
GAS
RESIDENTIAL iZNE
0 NEW
REMARJrZ
DNON-RESIDENTLkL SIGN
D�w RETAINING
WALL
E]
DEMOLISH
ElALTER EXCAVATE FENCE
E] OR FILL ( .......... X .......... Ft.)
El REPAIR PnE-movE SWIM
INSP. POOL
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Valuation Fee Receipt No.
Z
Plan Check No ................ . ...
PROPOSED USE
BUILDING
PLOT PLA.N (Indicate Building setbacks, abutting streets)
PLUMBING
to
HEAT & GA13 LINE
FENCE
SIGN
0
RETAINING WALL
SWIMMING 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 duty author-
ized agent of the owner. I agree to comply with city and state laws regu.
ATTENTION APPLICATION APPROVAL
lating construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Weshlngton
THIS PERMIT This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DE51OLITION'S which
ONLY TILE
WORK NOTED uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; J%IOVED-IN BUILDINGS shall be com-
knowledged in space provided.
pleted in six months.)
INSPECTION DIRECTOR'S SIGNATURE
DEPARTMENT ,
SIGNATURE (OWNER OR AGENT) DATE SIGNED
i0430�47
ze.
&i!
CITY OF
EDMONDS
IF
NOTE: Applicant Subject to Plan Chcck Fcc
C,
PR 6.1107
This Permit covers work to be done On private Property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FILE
numqueea, etc.) will require separate permission.