670511.pdfPERMIT APPLICATION inside Heavy Lines
NAME (OR NAJ40 OF BUSINESS)
4&A4X A/
MAILPIG ADDRESS
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CITY !FELEPRONE NUMBER
NAME
ADDRESS
CITY TELEPHONE NUMBER
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Legal Description of Property (Show Below or Attach Four Copies)
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GAS
NEW El RESIDENTIAL LINE
I E] NON-RESIDENTIAL SIGN
ElRETAINING
ElDEMOLISH WALL
DALTER EXCAVATE FENCE
D OR FILL ( .......... x .......... Ft.)
REPAIR PRE -MOVE swim
1:1 INSP. POOL
NUMBER Or STORIES NUMBER OF
DWELLING
UNITS
[W" MAP NO.: PERMIT
I NUMBER 670511
31DE YARD SETBACK'j
STREET SETBACK
REAR YARD SETBACK
0
USE ZONE
LOT MTL
Y^CMT SITE
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E)YES [I No
14EIGHT
BUILDING A
VARIANCE NUMBER
ow
PLOT PLAN APPROVED
STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ..........
REMARKS
CHECKED BY
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METER SIZE SERVICE SIZE CLEARANCE
BY
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ICHECKED
ed
REMARKS
TYPE CONNECTION
VERIFIED BY
PERC. TEST
PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
0 YES [:] NO
PLAN CHECKED BY
REMARKS
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Plan Check No .....................
PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
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N
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMNG POOL
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 author-
lzed agent of the owner. I agree to comply with city and state laws regu- 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 Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed in ninety days; AIOVED-IN BUILDINGS shall be com-
pleted In six months.)
5IGNATURE (OWNER GR AGENT) A INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Sitbject to P is Check Fee PR 6-1107
This Permit covers work to he done on privnte property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permlselon.
Valuation I Fee I Receipt No.
1 .3, 0 0 K40,11
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.
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