670452.pdfa -
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
A44�1,kl# .43. MATTI-56N
MAILING ADDRIGUIS /
Mao 3 P U/—
CITY
EPIVOWS W/V
P
or
46 7WI,
POSTED ON KROLL MAP NO.: PERMIT
,_� 0 1 �- I NUMBER 670452
[)DRESS
L 19
YARD SETBACK STREET SETBACK REAR iARD SETBACK
ZONE' LOT ARBA SIIE
NO
IT ARIANCE NUMBER ;W
�ER
EXISTING STREET R/W ............
COMP. PLAN ST. R/W ............
FT- DEFICIENCY THIS PROPERTY
FT- ............
Z
REMARKS
0
CHECKED BY
Z
41
METER SIZE SERVICE SIZE
-3 &( 0
14 3./4-
CLEARANCE
—
1 C74-T
I W�
MBZR
:F:-R
aEMARKS
UMBER
t M33E
TYPE CONNECTION
I
V T
)Pies)
PERO. TEST
PERMIV
I
REMARKS
GAS
2100N,EW g-IRESIDENTIAL R LINE
1 1:1 NON-RESIDENTIAL I El SIGN
0 �IJM RETAINING
WALL
0
DEMOLISH
ElALTER EXCAVATE FENCE
0 OR FILL El ( x n.)
.......... ..........
REPAIR PRE -MOVE swim
INSP. POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
TYPE
YES
[:] YES
IOUP
Valuation Fee
Plan Check No .....................
BUILDING .5
PLUMBING //
LINE
FENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION'
EXCAVATION OR FILL
TOTAL A!%IOUNT 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-
ized agent of the owner. I agree to comply with city and state laws regu-
ATMNTION
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
TIUS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TIIIE
WORK NOTED
ahpjl be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
;IGNATURE (OWNER OR AGENT) DATN SIGNED
INSPECTION
7
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Sitbicct to Plan Check Fee
PR 6-1107
This permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees. etc.) will require separate permission.
I �4g., 5-& 1 .
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
5
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