670214.pdfPOSTED ON KROLL MAP NO.: PERMIT
NUMBER 67
TMENT 0" 14
BUILDING DEPAR Applicant Fill
Inside Heavy Lines JOB ADDRESS
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
7A C 5 .5i— /i? 131DE YARD SETBACK STREET SETBACK REAR YARD SETBACK
_< 49, 67- 1?,A
MAILING ADDUNkid
USE ZONE T AREA A_ITE
VAG
017T TELEPHONE NUMBXR
[3 YES [3 NO
HEIGHT BUILDING AKEA
M a /Y Oro
NAME,
PLOT P]
X&S
ADDS
STREET R1W
MR EXISTING STREET R/W ............ IrT. DEFICIENCY THIS PROPERTY
70ITY TELEPHONE NUMB 1 0
COMP6 PLAN ST. R/W ............ FT.
REMARKS
WAKE
CHECKED
ADDRESS
METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
W
CITY TELEPHONE NUMBER
REMARKS
-�STATE LICENSE NUMBER CITY LICENSE NUMBER
TYPE CONNECTION VERUIIED BY
Legal Description of Property (show Below or Attach Four Copies)
PERO. TEST PERMIT NUMBER
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REMARKS
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I= ZONE TYPE OF CONSTRUCTION STREET IMPROVED
t4/ 1 4 6:6 141
YES NO
IQUIRED JOCCUPANCY GROUP
4' 40
06 0 YES ta
sfvfi� clip, k//V. PLAN CHECKED BY
GAS
RESIDENTIAL LINE
TEW NON-RESIDENT REMARKS
IE] IAL SIGN
[ErADD RETAINING
DEMOLISH WALL
2"ALTER EXCAVATE FENCE
D OR FULL .......... x .......... R.)
E] REPAIR PRE -MOVE swim
El INSP. POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
CA
C
W0411A0911
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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-
latlng 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; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
ATE: Applicant Subjcct to Plan Chech, Fcc
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.
Valuation
Plan Check No .....................
No.
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE;
ATTENTION
APPLICATION APPROVAL
TIUS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY TII[E
uty; and fees are paid, and receipt is ac-
WORK NOTED
lmowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
FILE
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