670320.pdf8
Z
D ON 91FOLL MAP NO.:
PERMIT
NUMBER
670320
DDREBS
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YARD SETBACK STREET SWTOAU&
Mt YARD SETBACK
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y
L5
ZONE
I
LOT AREA
I
VA�NT SITE
YES
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M�nlnn AnInk
I VARIAN0,19 1 qUIA ER
STRVUT R/W
EXISTING STREET R/W
............ FT- DEFICIENCY THIS PROPERTY
0
TE"FHGNZ Nu��
;F.
COMP. PLA.N ST. R/W
............ FT. ..........
REMAlUfS
CHE ED BY
Z
-7
TlauErAlONE NUMBER
METER SIZE SERVICE
SIZE CLEARANCE CHECKED BY
NUMBER
!" dd
-UI—TY LICENSE NUMi
REMARKS
II LICENSE
of Property (Show Below or AttaC h Four Copies)
TYPE CONNECTION
VERIFIED BY
_603trili
�k. CA-
PERO. TEST
PERMIT NUMBER
Dr., r)
REMARKS
I= ZONE TYPE OF CONSTRUCTION STREET IMPROVED -A
YES 0
-Ai-
;1C.)
K) n P_ t, C) 6 (!1 1-f� V_-
YES
YES
PLAN
PLAN
RESIDEN L
G 8
LINE
MAI
MAI
El
NEW
NoN-RESIDENTIAL
SIGN
ADD
RETAINING
DEMOLISH
FIWALL
ALTER
EXCAVATE
OR FILL
PENCE
( .......... x .......... Ft.)
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
MUM-131-3ROF W'�ORIESNUMBER
OF
DWELLING
UNITS /D/B 4-1je.,
1 /71
Plan Check No .....................
PROFOSEV ii BUILDING
A4 I %dicate Building si aQUET1n8'5LrUtV5) PLUMBING
7
103
HEAT & GAS LINE
PENCE
t SIGN
IL-7 r1l I
'I RETAINING WALL
SWIMMING POOL
%
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AJIIOUNT DUE
I hereby atkV6vWe_dge that I hav-0 ;Cfl� this 11111111catil. that the in-
formation given Is correct; and that I am the owner, or the duly author-
ized agent of me 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
rolatIng to Workman's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; AIOVED-IN BUILDINGS shall be com-
pleted in six months.)
INSPECTION
I—StG-N—ATURE (OIA ZFR OR AGENT) DATE SIONE
L
DEPARTMENT
CITY OF
EDMONDS
NOTE-: APPVcant Subject to Plats heck 'Ce PH 6-1107
This Perri covers work to be done on private property ONLY.
Any construe Ion on the public domain (curbs, sidewalks, driveways,
etc.) will require separate permission.
A c1P=r �Iocuolevemesn�tcc
Valuation
Fee I Receipt No.
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or Ills Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
S SIGNATURE
IDATE "1 :1 - i I- (or) 6", .—
FILE
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