670442.pdfI
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BUILDING DEPARTMENT
.
ON
PERMIT APPLICATION
Applicant Fill
Inside
17 Heavy Lines —jOB
POSTED ON KROLL MAP NO.: PERMIT
NUMBER
670442
'AD7DREus
_tl�k
A/0
7EN
NAME (OR NAME OF BUSINESS)
SIDE YARD SETBACK
STREET SEW33ACK
REAR YARD SETBACK
MAILING ADDRESS
,7A 4P A/O
USE ZONE
LOT AREA
VAUAN'A7 13EKM
0 YES [3 NO
CITY 1
TELEPHONE NUMBER
;E
HEIGHT
BUILDING AREA
VARIANCE 14UMBER
/ a 1'a'?1-
Ina. '2- 40 gZ;Z1
STATE LICENSE Numa"Na
2- Z
Legal Description of Property (Show Below or
NEW
RESIDENTIAL
GAS
LINE
NO N-RESIDENTIALI
0
SIGN
RETAINING
WALL
DEMOLISH
ALTER
EXCAVATE
OR FILL
El
PENCE
( A Ft.)
......... . ........
REPAIR
El
PRE -MOVE
INSP.
SMM
POOL
NUMBER OF
DWELLING
UNITS
EXISTING STREET R/W ............ FT.
COUP. PLA14 ST. R/W ............ FT.
DEFICIENCY THIS PROPERTY
....... .... 3".
a
1FEMARKS
CHECKED BY
M9rER SIZE] I SERVICE SIZE
MA.RKS
TYPE CONNECTION
VERIP70D BY
PERO. TEST
PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
[] YES NO
SPECIAL INSPECTOR REQUI
13 YES [3 NO
OUPANCY GROUP
r
5
Plan Check No .....................
PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
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 Is 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 re9U-
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 Workmewn Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE51OLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
INSPECTION
DEPARTMENT
CITY OF
SIGNATURE (OWNER 0 AG NT)
DATE SIGNED
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PH 6.1107
--This Permit coven work to be done on private Property ONLY -
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate Permission-
Fee I Receipt No.
1P-_JW97W1MiFdFJ=2
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and rec-1-1- is Sic-
mr, - -
knowledged in space provided. I
wer�j7e
DATE
FILE
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