670163.pdf------------------ ---- .. ..
_70'8TEDON KROLL MAP NO.: PERMIT
NUMBER
ncD A DTRACRIT I AF r� 670163
D U I LUII'1%7
ApplIcant R
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
_iMUNG -ADDRESS
Z
PHONE NUM13XR
CITY
iADDI=8
TELEPHONE NUMBER
E NUMBER
?.STATE LICENSE NUMBER 76ITY -LICENSE NUMBER
Legal Description or k1roperty (Show is -low or Attach Four C;;Ies)
!97
RESIDENTIAL
GAS
urqh;
NON-RESIDENTIAL
0
0 SIGN
RETAINING
ElDEMOU
D WALL
EJALTER EXCAVATE
El OR FILL
PENCE
( X Ft.)
.......... ..........
REPAIR F_1 PRE -MOVE
INSP.
SWITIT
F� POOL
DWELLING
UNITS
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I
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-
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 DEMOLITIONS Which
shall be completed In ninety days; 31OVED-IN' BUILDINGS shall be com-
pleted In Rix months.) I
NOTE: Zppficant Stibi;Xto Plan Ch'ech Fele
This Permit covers work to be(done on private property ONLY.
Any construction on the public domain (enrbs, sidewalks, driveways,
marquees, etc.) will require separnte permission.
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3IDE YARD SETBACK STREET SETBACK
nEAR YARD SETBACK
e)
5
/y, I M
-
USE ZONE LOT AREA
VACANT SITE
YES 13 14
HEIGHT ijUMDING
AREA
VARIANCE NUMBER
114
PLOT PLAN APPRU'VED
Z� 4,
STREET R/W
EXISTING STREET R/W W1. ..FT.
DEFICIENCY THIS PROPERTY
0
COMP. PLAN ST. R/W
.... go .FT.
REMARKS
CHECKED BY
0
Z
N
,V SIZE
METER SIZE BE li�VIC CLEARANCE
C
C9
'REMARKS
TYPE CONNECTION
VERIF
B
PERC.TEST
PERMIT XQ!!!TR
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION
STREET IMPROVED
YES El NO
SPECIAL INSPECTOR REWWAND
OCCUPANCY GROUP
[3 YES [3,NO
PLAN CHECKED BY
REMAIJKB
Valuation
Fee Receipt No.
Plan Check No .....................
BUILDING
Q
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
%L
APPLICATION APPROVAL
ATTIENTION
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
DEPARTMENT
TURA
CITY OF
EDMONDS
PR 6-1107
FILE
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