670025.pdfInside Heavy Lines JOB ADDRESS U.V�lo
PERMIT APPLICATION
AM19 OF LIUMINES31
NAME (OR 4W/1
SIDE YARD SETBACK. STREET SETBACK REAR YARD SETBACK
WAILING ADDRESS
P41 USE ZONE LOT AREA VACANT SITE
97P4 1go? 'P�J -5-1z)
CITY rELE HONED NUMBER 0 YES 0 NO
ZX —IVAIUANCENUMBER
74e//S__ HEIGHT 13UILDIRG XTM-A RIA
NAME FL—OT PEAN APPROVED
ADDRESS
STREET R/W
E)USTING STREET R/W ... 61 .... FT. DEFICIENCY THIS PROPERTY 0
CITY TELEPHONE 14UMBER 4
Z/ '7 '3.1 COMP. PLAN ST. R/WA*..11'...FT.
NAME
CHEICKF�D BY
ADDRESS
S'^-
70 METER SIZE SERVICE SIZE rLEARANCE CRY BY
CITY - TELEPHONE NUMBER it 0:
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Z dn'_W�wr 0 1 R N RIC
13TATE LICENSE; NUMBER Urry LICENSE NUMBEkt
27-3.-e/ dIng TYPE CONNECTION VERIF71JR BY
Legal Description Of Property (F im? or At7tich Four Copies) N�
PERC. TAST PERMTrKt!!rER
7al� 1 -�2
REMARKS
6�9 �d�
P FIRE ZONE TYI�E OF CONSTRUCTION STREET IMPROVED
1[3 YES NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
0 YES NO
PLAN CHECKED By
W-1001 GAS
B�NEW` RESIDENTIAL D LINE REMARKS
NON-RESIDENTIAL SIGN e-,e z2
F1ADD RETAINING
DEMOLISH WALL J///;P 464 /r- 4-
rE JAJ
F-1 ALTER EXCAVATE FENCE
F OR FILL El ( .......... x .......... Ft.)
El REPAIR PRE -MOVE swim 'eVIZ4
1:1 INSP. POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NAT E OF WORI T70 E D
71, Valuation Fee Receipt No.
Z
0 Plan Check No .....................
e, - ilg' —
PMPOBED USE
BUILDING
-1 17 _5� (,,o
U
PLOT PLA16 (Indicate BU ding setbacks, abutting streets) PLUNMNG
0
0 HEAT & GAS LINE
PENCE
t SIGN
N
IN RETAINING WALL
SWIM No POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the in- TOTAL AMOUNT DUE
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 laws regu- ATMNTION 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 Washington THIS rER31IT This application Is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Off Icial or his Dep-
ONLY THE
NOTE: Permit Limit One Your (Except DE31OLITIONS whIch WORK NOTED uty; and fees are paid, and receipt is ac-
shall be completed in ninety days: J%IOVED-IN BUILDINGS shall be com- lmowledged in space provided.
pleted in six months.) INSPECTION _f)7jF_.2CTQRkP SIGN TPRE
SIGNATURE,A0W1' pkGENT) DATZ. SIGNED DEPARTMENT
CITY OF DATE r
EDMONDS
NOTE: Applicant Stibject to Plan Check Fee Fn 0-1107
This Permit rovers %vork to be done On private property ONLY.
Any construction on U18 Public dOmsIn (curbs, sidewalks, driveways, FILE
marquees, etc.) will rOqn1ro separate permission.
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