680019.pdfPOSTED ON KROLL MAP NO.: PERMIT 6800 1 V
NUMBER
BUILDING DEPARTMENT Applicant Fill /0_:� E, I
inside Heavy Lines JOB ADDRESS Aj
PERMIT APPLICATION 7 -A
NAM (OR NAME OF BUSINESS) '7 — -7 �7
7- 71y�� -
131DE YARD SETBACK I STREET SETBACK REAR YARD ETBACK
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04
CITY
TELEPHONE NUMBER
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HEIGHT
BUILDING AREA
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VARIANCE 14UMBER
NAME
PLOT PLAN APPROVYD
00,
A.DDRESS
STILEE192r/W
EXISTING STREET R/W V/_�LFT. DEFICIENCY YTIIS PROPERTY
COMP. PLAN ST. R/W Z.4 .. FT. .... .......
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CITY TELEPHONE NUMBER
REMARKS
NAME
/h er
ADDRESS
C100 BY
.41
CITY
wif."k,11UNN au ER
METER SIZE SERVICF SIZE
CLEARANCE
CHJtWD BY
STATE LICENSE NUMBER
C2. 0
CITY LICENSE NUMBER
Legal Deseription of Property (Show Below or Attach Four Copies)
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TYPE CONNECTION
VERJ4qF BY
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PERC. TEST
FEFBUUMBER
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REMARKS
Z-4-x. 771�4 PL; a/.
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
-717— [] YES 9111�0
SPECIAL INSPECTOR REQUIRED
YES ev�o
OCCUPANCY GROUP
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RESIDENTIAL I
NEW NON-RESMENTIK BI
I D J IGI:
RETAINING
ElDEMOLISH WALL
ALTER EXCAVATE VENCE
0 OR FILL F-1 ( .......... X .......... Ft.)
REPAIR PRE -MOVE swim
1_1 INSP. 11 POOL
PLAN CHECKED BY
I
4
NUMBER OF STORIES
n 4- 11�_,
NUMBER OF
DWELLING
UNITS
Al;cerlu 6�t d 4
Z
0!S_05iXj
Plan Ctieck No ............ . .......
IPROPOSED USE
BUILDING
-
3
treets)
PLUMBING
ft
HEAT & GAS LINE
TFENCE
1h #
cc 2+
3)
N
SIGN
RETAINING WALL
SWI NG 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-
Ized 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
ATTE NTION
will be employed in violation of the Labor Code of the State of Washington
THIS rER5IIT
relating to Workman's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shan be cc 1 1 d In West da - MOVED -IN BUILDINGS shall be com-
Ap a Y;_�11
99 me e
pleted i5eil nths.)
INSP ECTION
DEPARTMENT
CITY OF
EDMONDS
�SXG-NRE (OWNER AG T)
7
DATE SIGNEB_
N&E: Applica'nt Subjhlt to Plan Check Fee
PR 6-1107
This rennat coven work to be done on private property ONLY.
Any construction on the pubtle domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation Fee Receipt No.
421
APPLICATION APPROVAL
TWs application Is not a permit until
Signed by the Building Official or Me Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
DIRECT , OR'S S19N#TU
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