670085.pdfW
POSTED ON KROLL MAP NO.: P IT
UILDING DEPARTMENT Appl1cant Fill 0 NUMBER 670085
Inside Roavy Lines -FOB —ADDRESS
ERMIT APPLICATION
'�NAMA (OR NAME
OF BUSINESS)
SIDE YARD SETBACK i_T_REFTF SET1511LUA. IUuA.R YARD SETBACK
G ADDRESS /0,
, ti USE ZONE LOT AREA VACANT SITE
TE—LEPRONE I NUMBISIR t-71 E3 No
(A C, I I � I 1jujLIj1ffG A—REA VARIANCE NUMBER ;k
HEIGHT
NAME
VED
PLOT PLAN APPRO
ADDRESS
STREET R/W
Cy THIS PROPERTY
—1 TELEPHONE NUMj3ffF-- EXISTING STREET R/W ............ FT. DEFICIEN
COMP. PLAN ST. R/W ............ FT.
REMARKS
NA.ME
A:, CHECKED JB.
�c 2K
L_5 -3 y TEIEI� SIZE SERVICE SIZE CLEARANCE C
CITY TELEPHONE NO V
d Ju
8 CITY LICENSE NUMBER
STATE LICENSE NUMBER
TYPE CONNECTION VEItIFVD.)3Y
Lagoa Description of Property (Show Below or Attnch Four Copies)
L PERC. TEST PERM7lT\,NVMBER
RESIDENTIAL
GAS
LINE
NEW
NON-RESIDENTIAL
SIGN
ElDEMOLISH
0
RETAINING
WALT
DALTER
EXCAVATE
PENCE
0
OR FILL
( x Ft.)
.......... ..........
El REPAIR
Q
PRE -MOVE
INSP.
El
SWIM
POOL
TUMBER OF STORIES
NUMBER OF
7-
DWELLING
UNITS
UTURE OF WORK TO HE DoNE
(Al
-IARKS
YES
AL INSPECTOR REQUIRED OCCUPANCY GROUP
0 0 YES ff-I �0
rPL�AN, CHI
REMA
I
Plan Check No .....................
BUILDING
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
—I EXCAVATION OR FILL
PLUMBING
BEAT & GAS LINE
PENCE
t SIGN
TOTAL A31OUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given to 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-
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
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DE'51OLITIO'NS which
shall be completed in ninety days: BIOVED-IN BUILDINGS shall be com-
pleted In six monthsj x R AGENT) DATE SIGNED
NOTE: Applicant Subject to Plan Cbeck Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
ATMNTION
THIS PER1%IIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
Valuation
Fee Receipt No.
�_,. S
3.0
- __� n
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
"1RV.V_TnRlR RTGNATTHIE I -
FILE
- 4
RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial) 4
(Rough) V'—* 6 2
Frame
Furnace & Fuel Lines 2
Final _7