670445.pdfn�pi POSTED ON KROLL MAP NO.:
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,R 610445
BUILDING DEPARTMENT Appill7cant Fj,1U r) E I
114�. PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
NAM (OR NAME OF BUSINESS)
J.
A1.0 /77 i set. /I
SIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK
MAILING ADDRESS
1Z
P0 M / f( j -S
USE ZONE VACA.NT SITE
1 LOT AREA
CITY TELEPHONE NUMBER [3 YES E] NO
zl� I I
HEIGHT 33UILDING AREA VARIANCE NUMBER
NAYE
P W/Lo LAN A OVED
#A/e- 5 224( /7 177 —C
STI�XET R/W
CITY 4Z TELEPHONE NUMBER EXISTING STREET R/W .5 ....... FT. DEFICIMCY THIS PROPERTY
COMP. PLAN ST. R/W 4re..Vr.
"-1*2 REMARKS
NAM
'Ple /7/77 'P Ls r-;� !> CHECKED BY
Z
ADDRESS
'9P/ -2 YA RAV
Al METE]t SIZE SERVICE SIZE
CITY TE ONE NUMBER ICLEARANCE
RVMAHKS
STATE LICENSE NUMBER CITY LACENSE NUMBER
v TYPE CONNECTION VERn?7E
Lagoa Description of Property (Show Below or Attach Four pop�ea)
-FE--Rc. TEST PERMJIT 'Qj!!SER
:n �-5 REMARKS
FIRE Z
ONE TYPE OF CONSTRUCTION STREET IMPROVED
YES
rZ _JZ 1 0-0-0 1
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUF�__
YES M-N�
PLAN CHECIS'p
D
GAS
RESIDENTIAL
NEW LINE
I N NON-RESIDENTIAL SIGN
ElADD RETAINING
1:1 DEMOLISH El WALL
F] ALTER EXCAVATE FENCE
OR FILL ( .......... X .......... Ft.)
E] PRE -MOVE swim
REPAIR INSP. POOL
N U-1 NUM_
DWELLING
UNITS
I OF
NATURE OF WORK TO BE'D7
_j
Z
FROPOSED USE Plan Check No .....................
BUILDING
PLOT PLAN (Indicate —Building setbacks, abutting streets) PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALT
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A51OUNT DUE
I hereby acknowledge that I have read this application; that the In-
furmatlon given to correct; &nd 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 Waahlngtan THIS PER130IT
relating to Workmen's Compensation Innuranee. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which IVORH NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
plated In six months.)
SIGNAT—U—RE(OWNER OR AGENT) INED INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This Porynit coven work to be done on private property ONLY.
Any construction on the Public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation
roe
-C) I t/ 0 1 t-
APPLICATION APPROVAL
This application Is not a perynit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
"i -
e'i . —/9�
FILE