670034.pdf—POSTED ON KROLL-MAP NO.: PERMIT
BUILD NG DEPARTMENT Applicant Fill NUM7B 670034
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PERMIT APPLICATION
F" u '7'
1 M(O 7 AMI0 OF BUSINESS)
I AME R N
�CTkRXA� VACANT SITE
F, USE ZONE YES E3 NO
LTIY I TELEPHONE UMBER aANCE NUMBER 04
19 427 68 W clkt (0 585 HEIGHT 0 E�j 1,55—ING �AREA
AME I
PLOT -PLAN APPROVED
DDRESS
ST EET R/W RTY
ITT TELEPHONE NUMBER EXISTING STREET R/W ............ FT. DEFICIENCY TH113 PROPE
COUP. PLAN ST. R/W ............ FT- ........... 1157r.
RE LARKS
[ABLE
CIMMED BY Z
N
,DDREBB
METER SIZE BE ARANCE CHECKED BY
1:4
)ITY TELEPHUNN 14UAWFAt
ITATE LICENSE NUM13ISkt CITY LICIUNSE NUMBER TYPE CONNECTION VERIF,=v BY
Legal Description of Property (Show Below or Attach Four Copies)
-Ot 10 12CvS rclwl�d %4� 4 3c"Vie—WI nk PERC. TEST PERMIT NUMBER
REMARKS
22"C--
I FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
M �Aav,-e_e 454 ISO -rhey%ee_I)C� 4 U I 1 0 YES 0 NO
SPECIAL INSPECTOR nEWUlkLED OCCUPANCY GROUP
1'6eV\V_-e_ to TOTVJO� k3eQ%-yv%N%-V%d YES [3 NO
J PLAN CHECKED BY
GAS
NEW RESIDENTIAL F-1 LINE REMARKS
NON-RESIDENTIAL SIGN
KIADD RETAINING
DEMOLISH WALL
F� ALTER EXCAVATE FENCE
OR FILL ( .......... x .......... Ft.)
REPAIR PRE -MOVE SWIM
INSP. -NUMBER OF POOL
DWELLING
UNITS
NATURE OF WORK TO BE DONE
aid (�ijovl\ I o( y t2f Valuation Fee
PlanCheck No .....................
PROPOSED USE 0 7
BUILDING 00 0
PLOT PLAN (Indl Building aFtFa—CkS. abutting streets) PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
E.3 $11 N C c. I
RF—St DZA SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
ISWXY P�Fl _\A/ TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given In 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- 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 Washington THIS PEILMIT This application IS not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building official or his Dep-
ONLY THE
NOTE: Permit Limit one Year (Except DEMOLITION'S which WORK NOTED uty; and fees are paid, and receipt Is ac-
shall be completed In ninety days: MOVED.IN BUILDINGS shall be com- knowledged in space provided.
pleted In six months.)
HIGNATURE (OWNNU Vn Auzrll) INSPECTION DIRE 0 K'SIGNAZ
DATE SIGNED DEPARTMENT
CITY OF DATE
EDMONDS
NOTE: Applicant Subject to Plait Check Fee PR 6-1107
This Permit coven work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, FILE
marquees, etc.) will require separate permission.
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