680013.pdfPOSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applil=t FIR 42 NUM13UR 680013
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ION
PERMIT APPLICATIAN Inside 11cavy Lines JOB ADDRESS
NAME (OR NAME OF BUSINESS) 7�7�7
-HEAR YARD SETBACK
SIDE YARD SETBACK, I STREET SETBACK
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DEFICIENCY
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PROPERTY
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S-Wol 6r 4 alc Pr METER SIZE SERVICE.SIZE CLEARANCE C19V4D BY
VATE LICENSE NUMBER CITY LICENSE 14UM-13ER
Z4;13 -0/ REMARKS IQ
egal Description of Property (Show Below or Attach Four Copies)
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TYPE CONNECTION VERII BY
Sff, of 4,o PERC. TEST PXRsUI�3UMBFR
Add To REMARKS
FIRE ZONE TYPE OF CONSTRI!P=ON STREET IMPROVED
YES )KINO
SPECIAL INSPECTOR REQUDWD OCCUPANCY GROUP
GAS YES %-jCLNO T
NEW RESIDENTIAL JNE PLAN CHECKED BY I
NON-RESIDENTIAL SIGN
RETAINING REMARKS
0 DEMOLISH f7 WALL
ALTER EXCAVATE FENCE
El OR FILL ( ......... x .......... Ft.)
REPAIR PRE -MOVE SWIM
INSP. POOL
DWELLING
UNITS
r.-O
Valuation
Plan Check No ................ ....
BUILDING
PLUMBING
10
HEAT & GAS LINE
FENCE
t SIGN
RETAINING WALL
SWIMMING POOL
I harebk'acknowledsa that I have real A arpplication; that the in-
formation given Is correct; and that I am the owner, or the duly author-
Ized agent of the 3wner. I agree to comply with city and state laws regu-
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Codo of the State of Washington
relating to Workmen's Compensation Inauranoe.
NOTE: Permit Limit One Year (Except DEMOLITIOINS which
shall be completed In ninety days: MOVED -IN BUILDINGS shall be corn.
plated In six months.) .11
NOTE: Applicant Siibject to Plan Check Fee
This Permit covers work to be done an private property ONLY.
Any construction on the public domain (curbst sIdewalkso drivowayso
marquees, etc.) %vlU require separate permission,
Fee
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No.
-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
xei
NPRE
AT17,NTION
APPLICATION APPROVAL
TIMIS PEWTIT
This application is not a permit until
AUTHORIZES
signed by the Building Official Or his Dep-
ONLY TIM
WORK NOTED
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
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