670267.pdf00_WAMMMIP�
PERMIT
IBM TED ON KROLL MAP N NUMBER b70267
'ING DEPARTMENT Applicant Fill
Inside Heavy L11nes JOB ADDRESS
F Ll
AAf
'OF BUSINESS)
, I " SIDE YARD SETBACK bT11WVL' tWK"AVV`
nD a
USE ZONE LOT AREA VAuANT SITE
TELEPHONE NUMBER I [] YES C3 NO
mamas P9, Ir -gp b-550 I—fN-1—GuT BUILDING AREA __FVAAIANCE NUMBIN_ ow
or
,
RESIDENTIAL
GAS
LINE
NEW
IE]
NON -RESIDENTIAL
F-1
SIGN
El..
RETAINING
0
WALL
D ALTER
0
DEMOLISH
EXCAVATE
OR FILL
Pf;jE
_fS I
x Ft.)
.� ..........
. ......
El REPAIR
PRE -MOVE
INSP.
swim
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
EXISTING I STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. .......... in.
REMARKS
CHECKED BY Z
I I ;a
METER SIZE I SERVICE SIZE CLEARANCE CHECKED BY
REMARKS
TYPE CONNECTION VERIFIED BY
PERC. TEST PERMIT NUMBER
REMARKS
I= ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 YES NO
SPECIAL INSPECTOR RMQUTR D JOCCUPANCY GROUP
E3 YE13 [] NO
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
I hereby arknowledgo 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
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
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed in ninety days: MOVED -IN BUILDINGS shall be com-
pleted In six months.) PECTION
1IONATURE (OWNER Oft AGErjT) DATE SIGNED INS
I DEPARTMENT
IM0 CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This Pern'dt covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marQuoes, etc.) will reQuIre separate permission.
Valuation I Fee I Receipt No.
- _00
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.
D I R2E VO)�t'S 10 N A
DATE
FILE