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POSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant Fill NUMBER 670252
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PERMIT APPLICATION Inside H q7L1 JOB ADDRESS
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INAM (OR NAME OF BUSINESS)
- to, - - � _kTn�. VARD SETBACK I STREET SETBACK REAR YARD SETBACKI
M LING ADDREdS
26
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�VAOANT
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USE ZONE LUT I SITE
7 :A3 e-`15 2e�
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1
0 TELEPHONE NUMBER
CITY
E] YES NO
1
1
-_
HEIGHT BUILDING AREA VARIANCE NUMBER
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NAME
PLOT PLAN APPROVED
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ADDREBS
STREET R1W
EXISTING STREET R/W ............
FT. DEFICIENCY THIS PROPERTY
CITY TELEPHONE NUMBER
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COMP. PLAN ST. R/W ............
PT. ........ ...
REMARKS
NA
CHECKED BY
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ADDRESS
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METER SIZE SERVICE SIZE
CLEARANCE CHECKED BY
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CITY w"PHONE NUMB0F_
REMARK13
STATE LICENSE RUM—BER CI CENSE NUMBER
TYPE CONNECTION
VERIFIED BY
Legal Description of Property (Show Below or -Attach Four Copies)
PERC. TEST
PERMIT NUMBER
REMARKS
L
A
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
[3 YES [3 NO
SPECIAL INSPECTOR REQUFR—ED OCCUPANCY GROUP
YES [3 NO
PLAN CHECKED BY
GJA S
RESIDENTIAL I NE
F� NEW
REMARKS
ElNON-RESIDENTIAL D SIGN
RETAIMNG
DDEMOLISH El WALL
ElALTER EXCAVATE FENCE
F-1 OR FILL ( ........ . x .......... Ft.)
REPAIR PRE -MOVE SWIM
El INSP. POOL
NUMBER OF STORIES 14UZWE" up
DWELT24NG
Ala-, UNITS
NATURE OF WORK TO BE DONE
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IF (7 /,-/
Valuation Fee Receipt N
— — 0.
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Plan Check No .....................
BUILDING
PLOT PLAN (Indicate Building setDaCks, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
-5
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-
ATTENTION
APPLICATION APPROVAL
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 PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DE31OLITIONS which
ONLY THE
WORK NOTED
ilty; and fees are paid, and receipt Is ac-
shall ho completed In ninety days; MOVE11,1N BUILDINGS shall be com-
knowledged in space provided.
plated In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGN ED
INSPECTION
DEPARTMENT
7�11.f
CITY OF
194
DATE
EDMONDS
NOTE: Applicant Stibject to Platt Ched, Fee
7
PR 6-1107
This Permit covers work to be done on privnte property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FILE
marquees, etc.) will require separate permission.
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