670070.pdfI
POSTED ON KROLL MAP NO.:
PERMIT
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BUILDING DEPARTMENT
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Applicant Fill
NUMBER
PERMIT APPLICATION
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inside Heavy Lines
JOB ADDRESS
NAME (OR NAME OF BUSINESS)
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SIDE YARD SETBACK
STREET SETBACK
ItNAR YARD SETBACK
MAILING ADDRESS
C;a 0 (40 S-0.
USE ZONE
LOT AREA
VACANT SITE
CITY
NU;
rjw"ru0NE1 NUMBER
0 YES [3 NO
FD MONDE
1?7 70
HEIGHT
BUILDING
AREA 1
VARIANCE NUMBER N
NAME
ADDRESS PLOT PLAN APPROVED
STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
CITY
TMMONE NUMBER
COMP. PLAN ST. R/W ............ FT. ....... .. FT.
REMARKS
NAME
16 lc� CHECKED BY
4co cov' Z
ADDRESS
62SI16- 41 14U METER SIZE SERVICE SIZE I CLEARANCE ICHECKED BY
CITY ONE NUMBER
/V/4 J Lilt REMARKS
STATE LICENSE NUMB= CITY LicENula. NIUMBER
;x 02- 3 0 / L.!f Y-6" 47 1 TYPE CONNECTION VFIRIFIED BY
Legal Description of Property (512ow Below or Attach Four Copies)
IV, /;1 4/. F I
rA7 PERO. TEST PERMIT NUMBER
F)q ii7 7,)�, 7 1 0 F 4 3 C/ REMARKS
Wj11ou)[)n4,i! (9149pen/9
FIRE ZONE TYPE; OF CONSTRUCTION STREET IMPROVW
0 F Or J�L I
YES [3 No
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
h0EC_ a R D S o F SNo Po Aii S* C c.
[:] YES NO
LU PLAN CHECKED BY
GAS
NEW RESIDENTIAL F-1 LINE REMARKS
El NON-RESIDENTIAL
SIGN
F)d RETAINING
1:1 DEMOLISH WALL
ALT.. EXCAVATE PENCE
F� OR FILL El ( .......... x .......... Ft.)
REPAIR PRE -MOVE swim
1:1 INSP. POOL
NUM13ER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
A Room Valuation Fee Receipt No.
Plan Check No .....................
PROPOSED USE BUILDING
T 0
Raoil"I _�. (-, S
-PLOT PLAN (Indicate Building setbacks, abutting streets) PLUMBING
HEAT & GAS LINE
PENCE
SIGN
N
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 tho owner. I agree to comply with city and state laws regu-
lating construction; and in doing the work authorized thereby, no person ATMNTION APPLICATION APPROVAL
will be employed in violation of the Labor Code of the State of Washington TIHS PERMIT This application is not a permit until
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relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE signed bytheBuilding Official or his Dep-
'S which
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
I rom
shall be completed In ninety days; DIOVED-IN BUILDINGS aball be com- Imowledged in space provided.
plated In six months.)
SIGNED INSPECTION
SIONAT WNjER ZORA EN DATE DIRECT0,R'S SIGNATURE
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plats 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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