670143.pdf-7
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POSTED ON KROLL MAP NO.:
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BUILDING DEPARTMENT Applicant Fill NUMBER 670143
Inside Heavy Lines JOB ADDREBS
PERMIT APPLICATIO14
NAME (OR NAME OF 7 SINEBS)
��GL&.5 SIDE YARD SETBACK IITIIE�T SETBACK REAR YARD BET13ACK
MAILING ADDRE135
a A4 CA40S t9 USE ZONE LOT AREA VACANT Bffk--
CITY TELEPHONE NUMB E3 YES rl NO
NAME HEIGHT 11 BUILDING AREA VARL&NCE NUMBER
PLOT PLAN APPROVED
ADDRES8
STREET R/W
CITY TELEPHONE NUMBER EXISTING STREET R/W ....... ... ST. DEFICIENCY TE38 PROPERTY
COMP. PLAN ST. R/W .... ...... XT.
REMARKS
CHECKED BY
—A—DBRESS Z
-g4:lq 14Aqwo&A-vt,= 9PvJ METER SIZE SERVICE 531-26—r—LEARANCE CHECKED 13T
CITY' TELEPHONE N
W
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STATE LICENSE NUMBER CITY LICENSE NUMBER
TYPE CONNECTION VTJUPIED BY
Legal Description of Property (Show Below or Attach Four Copies)
TERC. —TEST PERMIT NUMBER
Z
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 [3 YES 13 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
0 YES [3 NO
PLAN CHECKED 33Y
GAS
ElNEW El RESIDENTIAL El LINE REMARKS
NON-RESIDENTIAI, VSION
RETAINING
DEMOLJSH WALL
ALTER EXCAVATE PENCE
OR FILL ( .......... x .......... Ft.)
REPAIR PRE -MOVE SWIM
INSP. POOL
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
C 7- 74
Z Valuation Fee Receipt No.
Plan Check No .....................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
BEAT & GAS LINE
PENCE
t SIGN
N tE
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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 duly author-
ized agent of the owner. I agree to comply with city and state laws regu-
I&Ubg construction; and in doing the work authorized thereby, no person ArTENTKON APPLICATION APPROVAL
will be employed In violation of the Labor Code of Me State of Washington TMS PERMIT
relating to Workmews Compensation Laurance. AUTHORIZES This application is not a permit until
ONLY THE Signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS 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.
Piet I six months.)_4.
BIG A RE (0 SIGNME INSPECTION IGN
DEP
ARTMENT
CITY OF
EDMONDS DATE
41NOTE: APPlicant Subject to Plan Check Fee PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the Public domain (curbs, sidewalks, driveways, FILE
marquees, etc.) 1%,111 require separate permission.
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