670525.pdfF -
POSTED ON KROLL MAP NO.:
PERMIT 670525
BUILDING DEPARTMENT
Applicant Fill
NUMBER
PERMIT APPLICATION
Inside Heavy Lines
JOB ADDRESS
NAME (OR NAME OF BUSINESS)
V�_O 0 H C—: C— G5iL?1_
1
SIDE YARD SETBACK
SWREET SETBACK REAR YARD SETBACK
L �j
USE ZONE
1
LOT AREA VACANT SITE
1 [3 YES 0 NO
0
MAILING ADDRESS
7 / o / V
_61-TY TE&EPHONE
L-I)MO AID I
N
I
HEIGHT
BUILDING AREA. VARIANOii; NU �ER
I I
NAME
PLOT PLAN APPROVED
ADDRESS
STREET R/W
EMS77NG STREET R/W ............ FT. DEFICIENCY TH113 PROPERTY
OMP. PLAN ST. R/W ............ FT. .......... FT .
CITY- rUMBLIt
"RXS
Z i
NAME
)kl L Fir :5C— 7'� V i (ej�— C 0
CHE ED
c)(17
METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
REMARKS
CITY
SC�_A Mta
BER
D 7
STATE LICENSE NUMBER
CITY LICENSE NUMEWIS
TYPE CONNECTION
RIFIMD BY
I
Legal Description of Property (Show, Below or Attach Four Copies)
PERC. TEST
PERMIT NUMBER
REMARKS
FIRE ZONE
TYPE OF CONSTRUCTION STREET IMPROVED
[3 YES 0 NO
0T)MMAT. TMRVV.�nn
Rr.C1TyTfFr.-ni nrrTTPAN(1V aRnTIP
0 YES E3 NO
NEW
RESIDENTIAL
R
GAS
LINE
ElNON-RESIDENTIAL
1
0
SIGN
RETAINING
0
WALL
ElALTER
DEMOLISH
EXCAVATE
PENCE
0
OR FILL
( x Ft.)
REPAIR
PRE -MOVE
INSP.
.......... ..........
swim
POOL
NUMBER OF
DWELLING
UNITS
M
Plan Check No .....................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
N
RETAINING WALL
SWIMMING 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 to 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
THIS PERMIT
relating to Workmen's Compensation Insurance-
AUTHOIUZES
NOTE: Permit 11mit One Year (Except DE31OLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; 31OVED-IN BUILDINGS shall be eom.
pleted ln3j� months.)
8 N�,T�Ry (OW1'ZFek-'*R AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subicct to Plan Check Fcc
PR 6.1107
This Permit 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 I Fee
3. 0 C>
No.
ro 0
APPLICATION APPROVAI
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.
DIRC R,S;;
7.
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