670448.pdfPOSTED ON KROLL MAP NO.:.. PERMIT /U448
_�..-B U I LD1 NG DEPARTMENT Fill NUMBER
Inside neavy Lines
PERMIT' APPLICATION' JOBIADDRESS
NAME (OR NAME OF BUSINESS)
SIDE YARD SETBACK STREET SETBACK HEAR YARD SETUA CK
Pe ri L% c. ti
WAILING AADD Be
'10 e2 I �AePr3 U V\j A jj L E USE ZONE LOT AREA VACANT SITE
1. T\
TELEPRONIG NI ER E3 YES 040
d (A0 k\A d S 43 -'3 i�_cl 0 HEIGHT BUILDING AREA VARIANCE, NUMBER,
PLOT PLAN ED
PRO
"E 'PRO
ADDRESS
STREIMR/W
CITY TELEPHONE NUMBER NG STItairr R/W . . ........ FT. DEFICIENCY THIS PROPERTY
COUP. LAN ST. R/W ........... XT. .......... FT.
NAM10
CHECKED 13T z
ADDRESS
CITY TELEPHONE NUMBER METER SIZE SERVICE SIZE CLEA CHECKEM1 BY
STATE LICENSE RMER, CITY LICENSE NUMBER
TYPE CONNECTION VERIFIED BY
Legal Description of Property (Show Below or Attach Four Copies)
PERC. TEST PERMIT RMER
REMARKS
IQ
FIRE ZO TYPE OF CONSTRUCTION STREET IMPROVED
0
SP OTAT SPECTOR REqUIRED 13 YES
OCCUPANOY GROUP
0 YES
PLAN CHECII�p BY,/
NEW RESMENTIA L El =E REMARtV
NON-RESIDENTI
L SIGN
ADD .�j El RETAINING
WALL
DEmciwan
ALTER EXCAVATE PENCE
OR FILL ... . ... . x ..... .... M.) -7
REPAIR PRE -MOVE SWIM
INSP. POOL
El El
Ell NUMBER or
DWELLING
UNITS
0 tA'E I C ME (KIM)
'NATURE _0P WORK TO BE DONE
C
im 7 (�' I n
Valuation Fee Recelpt No.
0
Plan Check No ... . ......
PROPOSED USE
BUILDING
Xcp- �d' d", 7.-<7
PLOT PLAN (Indicate Building setback$, abutting streets)
PLUMBING
HEAT & GAS LINE
FENCE
MCI I I SIGN
119
'Mt T1 we RETAINING WALL
SWIMMING POOL
IV i4 DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby naltnowledgo that I have read this application; that the In. TOTAL A31OUNT DUE
formation given Is correct; and that I am the owner, or the duly author.
ized agent of the owner. I agree to comply with city and state lawn regu- ATMNTION 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 PERMIT This application is not a permit until
relating to Workmens Compensation Insurance. AUTHORIZES
ONLY THE signed by the Building Official or his Dep-
NOTE: Permit Urnit One Your (Except DE31OLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
shoal be completed in ninety days; MOVED -IN BUILDINOS ahall be com- knowledged in space provided.
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED INSPECTION DXRECTORIS SIGNATU
DEPARTMENT
CITY OF 1A
EDMONDS
I;" _ 7_
NOTE: Appli"nt Subject to Plan Check Fee PR 6-1107 7
This Permit covers work to be done on private Property ONLY.
Any construction an the public domain (cuzbs, sidewalks, driveways,
marquees. etc.) will require separate permission. FILE
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