670419.pdfPOSTED ON KROLL MAP NO.:
PERMIT
(o7041.9
BUILDING DEPARTMENT
PERMIT APPLICATION
Applicant Fill
Inside Heavy Lines
1 .2 z to
NUMBER
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JOB ADDRESS
NAME (OR NAME OF BUSINESS)
P-S /40 1-7 _S el
SIDE YARD SETBACK
( 0, M IM
STREET SETBACK
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REAR YARD SETBACK
- -1 .
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0
MAILING ADDRESS
) 99 2"? 2 It
USE ZONE
(F) �4 1 Q�—
I LUT AREA
VACANT SITE
1 0 YES 13 NO
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CITY
7
TELEPHONE NUMBER
P 2-1
HEIGHT
1 1 isuiLDING AREA
VARIANCE NUM!
1
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MY
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TELEPHONE N TIER
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EXISTING STREET R/W fle ... FT.
COMP. PLAN ST. R/W A. e) ... FT.
DEFICIENCY THIS PROPERTY
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REMARKS
AMS
CHECKED By
P. �7 1
DDRESS
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METER SIZE SERVICIf- SIZE CLEARANCE
CHFf�= BY
ETY
TELEPHONE NU �XR
rATE LICENSE NUMBER
0/
MBER
CITY LICENSE NU R
TYPE CONNECTION
VERIFIV yy
,egal Description of Property (Show Below or Attach Four Copies)
PERO. TEST
PERMIT r,13&BER
Se a V I e L�j 0 f- 9--V K? C� r_<1
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
1[3 YES a40
SPECIAL INSPECTOR REQUIRED
YES mno�
IOCCUPANCY GROUP
RESIDENTIAL
GAS
40
LIN
NEW
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NON-RESIDENTIAL
SIGN
ADD
=1
RETAINING
0
WALL
DALTER
DEMOLISH
EXCAVATE
PENCE
0
OR FILL
El
( (
1:1 REPAIR
1:1
PRE -MOVE
INSP.
......... . ..........
swim
POOL
"UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
TATURE OF WORK TO BE DONE
Plan Check No ............ .... ...
PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
-7
HEAT & GAB LINE
PENCE
SIGN
30.4
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL Al%JOUNT 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-
Ized agent of the owner. I agree to comply with city and State laws regu.
latIng construction; and In doing the work authorized thereby, no person
ATTENTION
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE51OLITIONS which
ONfLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS Shall be com-
plated In six months.)
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
nGNATURE (OWN OR AGENT)
DATE SIGNE�D_
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit covers work (A) be done on private Property ONLY.
Any construction on the public domain (curbs, Sidewalks, driveways,
,marquees, etc.) will require separate permission.
No.
Famp
1 1:7* /.�J _�� 3 Iq � - 0
APPLICATION APPROVAL
This application is not a permit until
signed by tile Building official or Ws Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE
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