670189.pdfV
POSTED ON KROLL MAP No.: PERMIT
NUMBER 670189
BUILDING DEPARTMENT Applicant Fill s
PERMIT APPLICATION Inside Heavy Lines JOB ADDIIE138
NAME (OR NAME OF BUSINESS) r7
ETot. rf rA 0S, In!, SIDE YARD SETBACK STREET SETBACK RE&H YARD SETBACK
MAILING ADDRESS a
? 9 / t q USE ZONE LOT AREA VACANT SITE
CITY TELEPHURNff RUMBEIR YES NO
HEIGIN BUILDING AREA VARIANCID NUMBER PA
NAME
PLOT PLAN APPROVED
ADDRESS
STREET R1W
CITY TELEPHONE RUMBER EXISTING STREET R/W ........... ST. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. .......
REMARKS
NAMM
15 e_-9 7-W A. L I %%-c Le u I a V�. 75 -FIC--IHIECKED BY
ADDRESS_�
0 0. -V W 4, M METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
CITY TELE7014M 14UMBLR Cd
REMARKS
ILA L-S-1 e-'
STATE LICENSE NUMBER JMHER
TYPE CONNECTION VERIFIED BY
Legal Description of Property (Show Below or Attach Four Copies)
&_ '�, y IV to - ), �u k/ I () o'
I
RESIDENTLA
G" S
LINE
NEW
1
0
1:1 NON-RESIDI TIAL
r �
SIGN
D—,LDD
RETAINING
F� DEMOLISH
FJ
WALL
0 ALTER
EXCAVATE
0 FILL
PENCE
Ft.)
OR
I .......... x ..........
REPAIR
PRE -MOVE
El
swim
POOL
INSP.
FUM13ER OF STORIES
NUMBER OF
DWELLING
UNWS
FARTURE OF WORK TO BE NE ,
I
of" 4
[3 YES [] NO
Plan Check No ...........
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
t
N
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
/%A ro &I
TOTAL A'MOUNT 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.
ATTENTION
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 PEWIIT
relating to Workman's Compennatlon Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY 11
WORK NOTED
shall be completed in ninety days: MOVED -IN BUILDINOS shall be com-
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
V_
EDMONDS
NOTE: Applicant Subject to Plait Check Fee
Pit 6-1107
This PermIt covers work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate Permission.
Valuation
M
[] YES [3 NO
Fee
1 /7.S-01
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.
I _7 �
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