670429.pdfPOSTED ON KROLL MAP 140';
PERMIT fU4Z7
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BUILDI G DEPARTMENT
PERMIT APPLICATION
Applicant Fill
Inside Heavy Lines
NUMBER
JOB ADDRESS
NAMIC (OR NAME OF BUSINESS)
SIDE YARD SETBACK
FT—REET SET I I 1 1111 REAR YARD SETBACK
7— Z
WAILING ADDRE05
USE Zo
LOT AREA 111 1116 � K M,
orry
(3 YES E3 NO
f
HEIGHT
BUILDING AREA VARIAINCE NUMBER
HAMM
t'pAe
P T PLAN APP ED
ADDIMIN
/W DEFICIENCY THIS PROPERTY
EXISTING STREET R/W .... ....... PT -
TELEPHONE N
COUP. PLAN ST. R/W ............ IT
REMARKS
NAME
Y
Z
j
ADDRESS
METER 0 E CLEARANCE
T=PHONE NUM33MB
REMARKS
WATZ LICI NUMBER
CITY LICENSE Ntl�
Typill CONNECTION
V FIND, BY
Law Description pe rty (Show �Iow or Attach Your Copies)
;—r- Z
PERIM NUMBER
PERC.
eo.
IVO
REMARKS
FIRE Z014E TYPE OF CONSTRUCTION STREET IMPROVED
E3 YES NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
[3 YES 0 No
PLAN CHECKED By
RESIDENTIAL
GAS
El LINE
NEW
REMAIMS
ElNON.RMDENTIAL
SIGN
ADD RETAINING
WALL
DEMOLISH
D ALTER EXCAVATE PENCE
El OR FILL ......... X .........
El REPAIR PRE -MOVE amm
INSP. POOL
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE
DONE
Aer 4 �r.Q /7")0/
Valuation
Fee
Z
0
Plan Check NO ........... . .......
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
BEAT & GAS LINE
PENCE
t
SIGN
&
N
RETAINING WALL
SWIMMING POOL
C90
/a �,&2 0
-7-
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given Is correct; and that I am the owner, or the duly auther.
ited agent of the owner. I agree to comply with city and state law a regu.
ATTENnON
APPLICATION APPROVAL
InI construction; and In doing the work authorized thereby, no person
in violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
will be employed
relatIng to WorkmeI Compensation Insurance.
AUTHO RIZES
signed by the Building official or his Dep-
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
"I be completad In ninety days; MOVED -IN BUILDINGS shall be com.
knowledged in space provided.
plated In six months.)
SIGNATLIRE, (OWNEIt OR DATE SIGNED
INSPECTION
DIRECTOR'S 810
DEPARTMENT
CITY OF
DATE
EDMONDS
NOTE: APIlicanAlbiect to Plan Check Fee
q-
PR 6-1107
This Permit covers work to be done on private property ONLY.
domain (curb@, sidewalks, driveways,
PILE
Any construction an the public
marquees, etc.) wW require separate Permission-
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