670248.pdfJ.'11 Dim= POSTED ON KROLL MAP NO-: PERMIT
UMBER
1'7BLU�IILDING DEPARTMENT Applicant Fill N 670248
PERMIT APPLICKFION
NAME (OR NAME Oil BUSIN SO)
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MAMN—GADDRESS
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CITY
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NAME
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Inside Heavy Lines
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JOB ADDRE138
SIDE YARD SETBACK 5TICN&;J: be�I�ACK I �REARYXARD SETBACK
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USE ZONE 1JUX �A VAUJ.L bl'x�
5P4�--_ / 2� 1 —1 801rEs 0 NO
(0 -
STREET R/Wg�0..FT. DEFICIENCY THIS PROPERTY
LAN ST. R/W/eg ... FT -
CITY
"I I
REMARKS
STATE LICENSE NU—MBER
TYPE CONNECTION
ED BY
Lagoa Description or rrOPejjy__(Show Below or Attao= 11OUr Copies)
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PERC. TEST P0,ZNUMBER
C-ITS
REMARK13
I= ZONE TYPE OF CONSTRUCTION
STREET IMPROVED
-77 �/ _]Z:
1 0 YES 240-
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
E]YES 040_�_
PLAN CHE D B
AS
RESIDENTIA E
REUA�
NEW ZM
NON -RESIDE NjTIAL F-1 SIGN
I
RETAINING
WALL
DEMOLISH
EALTER EXCAVATE PENCE
l OR FILL ( .......... x .......... Ft.)
E] REPAIR PRE -MOVE swim
INSP. POOL
8 I —NUMBER OF
DWELLING
UNITS
NATU-R OF WORK TO BE DONE
Vj
Valuation
Fee Receipt No.
Z
0
Plan Check No .....................
Fee
PROPOSED USE
BUILDING
40;'�
Res,
PLAN (Indicate )JU11CIM9 setbacks, abutting streets)
PLUMBING
A�r 40
/
0
HEAT & GAS LINE
R6.0
0
PENCE
to
SIGN
RETAINING WALL
SWIMMING POOL
rv)
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
1 -
TOTAL AMOUNT DUE
I hereby acknowlecigo, that I have read this application; that the In-
formation given '.- 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 rOgu-
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 DE3101JTIONS which
ATTENTION
THIS PERINIXT
AUTHORIZES
ONLY THE
WORK NOTED
shall be completed In ninety days: MOVED -IN BUILDINGS shall be com-
pleted In six months.)
INSPECTION
DEPARTMENT
CITY OF
310 OR AGENTI DATE SIGNED
�ZIATURE
�AX .0 4
Z
EDMONDS
NOTE: Atplicant Subject to Plan Check Fee
PR 6-1107
This ]Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sldeivnaks, driveways,
nearquees, etc.) will require sepoLrate, permission.
&� �1113L&26i
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.
U—IRECTOR'S SIONATURY ,f 7
7_
FILE
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