670520.pdfPOSTED ON KROLL MAP NO. PERMIT
NUMBER '670520
BUILDING DEPARTMENT Applicant Fill I
PERMIT APPLICAI Inside Heavy Lines
9 MAIbNG ADbRESS
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USE ZONE LOT AREA VACATrr SITE
IE NUMBhUt 0 YES 13 NO
YX VARIANCE NUMBER
I HEIGHT BUILDING AREA I at
PLOT PLAN APPROVED
STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ Fr. .......... . 1".
-TE—LEPHONE NUREBER
REMARKS
CHECKED BY z
METER SIZE I SERVICE SIZE CLEARANCE
CHECKED BY
TELEPHONE NUMBER
REMARKS
!ENSE NUMBER
NUMBER
TYPE CONNECTION
VERIFIZD BY
Iption of Property (Show Below or Attach Four Copies)
PERO. TEST
PERMIT NUMBER
REMARKS
N"11 /.74-1c 14
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RESIDENTIAL
GAS
LINE
NEW
NON-RESIDENTIAL 1
0 SIGN
ADD
DDEMOLISH
RETAINING
D WALL
ALTER
7
EXCAVATE
OR FULL
PENCE
F-1 ( . C
REPAIR
1:1
PRE -MOVE
INSP.
......... ..........
swim
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
jan a *�D I C__ C16 V
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-2,0
Ej YES 0 NO
SPECIAL INSPECTOR J�EQUIRED OCCUPANCY GROUP
S T
'0
PLAN CHECKEJ LBY
REMARKS
plate check NO .....................
BUILDING
PLUMBING
,butting streets)
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N
BEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
I hereby acknowledge that I have read thin 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- 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 TIUS PER2%IIT
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able
relating to Workmen's Compensation Insurance. AUTIIOIUZES
014LY THE
NOTE: Permit Limit One Year (Except DE51OLITI'ONS which WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
SIGN7A (OWNER 0 SIGNED INSPECTION
7E T) DATE _
DEPARTMENT
CITY OF
L sy — 2
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-110�
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
nmrque,es, etc.) will require separate permission.
Valuation
0 D
Fee
APPLICATION APPROVAL
This application is not a perinit 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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