670383.pdfPOSTED ON KROLL MAP NO-: PERMIT
BUILDING DEPA�RTMENT Applicant Fill NUMBER 670383
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS ztiot
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NAME (OR NAME OF BUSINESS) 0 REAR i�ARDSETB,
0 t4./ e— SIDE YARD S STREET SETBACK
lo 3 0
LINO JLDDRE138
USE ZONE LUT A�A
TELEPHONE NUMBER
& 2/fv - El YES NO
-CITY yj I I
lor -3 1 HEIGHT I BUILDING AREA I VAMAAJ
PLOT PLAN APPROVED
—A DRESS
�TELEPIIONE.,NUMBER
STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY 0
CITY 11
1".
COMP. PLAN ST. R/W ............ FT. ..........
REMARKS
NAME
we,(f e
CHECKED BY
ADDRESS
METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
CITY
REMARKS
STATE LICENSE NUMBER
CITY LICENSE NuMil R
TYPE CONNECTION VERIFIED BY
Legal Description of Property (Show Below or ttach F copies)
&Jv 4t/
PERC. TEST PERMIT NUMBER
zz/3
RE' MARKS
0
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 YES 13 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES [3 NO
PLAIT CHECKED 13Y
GAS
RESIDENTIAL F LINE
1z NEW
REMARKS
NON-RESIDENTIAL SIGN
FADD RETAINING
WALL
DEMOLISH
0 ALTER EXCAVATE FENCE
OR FILL F-1 ( .......... x .......... Ft.)
EIREPAIR PRE -MOVE swim
Ej INSP. E] POOL
NUMBER OF STORIES
I NUMBER OF
L7
DWELLING
UNITS
NATUREFOF WORK TO BE DONE
Valuation Fee RecelPt No.
z
0
Plan Check No .....................
BUILDING Z)
PROPOSED USE
streets)
PLOT PLAN (Indicate Building setbacks, abutting
PLUMBING
0
HEAT & GAS LINE
FENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
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-
lzed 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 PER311T 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 uty; and f ees are paid, and receipt Is ac-
shall be completed in ninety days; 31OVED-IN BUILDINGS shall be com-
knowledged in space provided.
pleted In six months.)
INSPECTION
DEPARTMENT DIRECT�R-S I SIONA U
SIGNATURE (OWNER OR AGENT)
CITY OF
DATE
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
F
This Permit covers work to be done on private property ONLY.
Any construction On the public domain (curbs, sidewalks, driveways,
FILE
marquees, etc.) will require separate permission.