670583.pdf. ............. ...
BUILDING DEPARTMENT Applicant Fin
DCDAAIT ADDIWATI N Inside Ifeavy Lines
NAM (OR NAME F BUFTS)
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AMS
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ELEPHONI
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)STED ON KROLL MAP NO.: PERMIT
I NUMBER 670583
/ CF1 / C52 - 4�', r
SIDE YARD BET13ACK STREET SETBACK REAR YARD SETBACK
(lot 1 51
USE ZONE —1 LOT AREA
-1 R� — 11.1 1 1 [] YES 11 NO
STR�E/%V
EXISTING STREET R/W ............ FT.
COUP. PLAN ST. R/W ............ FT.
DEFICIENCY THIS PROPERTY
..........
CITY
TELEPHONE NUMBER
REMARKS
NAME
Z
CICED BY
ADDI..
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
CITY
WIGLEk`1101415 NUMBER
REMARKS
STATE LICENSE NUMBER
CITY LICENSE NUMBER
TYPE CONNECTION
VERIFIED BY
Le Q D C I tio of Property (Show Below or Attach Four Copies)
6 r
Z6 4�
PERO. TEST
PERMIT NUMBER
Z
T r
REMARKS
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lve�
FIRE ZONE NSTRU=ON STREET IMPRO
TYPE OF co
[] YES Q-11
a
-SPECLILL INSPECTOR REQUIRED
OCCUPANCY GROUP
0 YES e-I �O
PLAN CHECKED BY
Z2 �/11_
GAS
El RESIDENTIAL
NEW LINE
pmvj NON-RESIDENTIAL SIGN
REMARK
ALTER
E-1
RETAINING
DEMOLISH WALL
EXCAVATE PENCE
OR FILL ( .......... X .......... Pt.)
REPAIR
PRE -MOVE swim
INSP. POOL
___7_
NUMBER OF STORIES
NUMBER OF
DWELLING
/01 V--v X)
UNITS
Plan Check No .....................
PROPOSED USE,
6
BUILDING
PLUMBING
PLOT PLAN (Indicate Building Setbacks, abutting streets)
HEAT & GAS LINE
FENCE
t
SIGN
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 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-
lating construction; and In doing the work authorized thereby, no person
ATTENTION
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 Otte Year (Except DEMOLITIONS which
shall be completed in ninety days; 31OVED-IN BUILDINGS shall be com-
ONLY THE
NVORK NOTED
pleted in six months.)
SIGNATURE (OWINNA AU4�11 DATE SIGNED INSPECTION
----- — DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0.1107
This Permit covers work to be done on privnte property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission,
Valuation I Fee
Z
1-
Z
No.
APPLICATION APPROVAL
This application is not a permit until
signed by Uie Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
FILE
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