680020.pdf. . ....... .
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POSTED ON KROa77'"PNO-'- PERMIT 00t_0
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NUMBER
E
BUILDING DEPARTMENT Applicant Fill
Inside Heavy Lines JOB ADDRESS
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
-A �SETBAC
SIDE YARD SETBACK STREET SETBACK RvAlt X��
MAILING ADJURNUIS
VACANT SITE
USE ZONE LOT AJIZA
�90 Z
Z�?
CITY I 'TELEPHONE NUMBER 1 [3 NO
Y
_FiU_1LDING AREA VARIANUM IN U
Go 04tal j 49 S
NAME
PLOT P
LAN APPROVD
170
STREETI"v
EXISTING STREET R1We0-_4C�_---FT. DrMCIENCY THIS PROPERTY
TELEPHONE NUMB
W CITY MR
PLAN ST. RJW4/1 .. d.-ST- FT.
COMP
REMARKS
NAME
94 -7—DDRESS
915E BY
CITY MBER
Z
MET SIZE SERVICE SIZE CLEARANCE CIL %FED BY
STATE LICENSE NUMBER CITY LICENSE NUMBER
Legal Description of Property (Show i3eiow or Attach Four Copies)
C, os- TYPE CONNECTION VE"Dipy
L07
Z
14-41, ft-t Al e d ?-jC41 At 1) it PERO. TEST PERMIT�,��BER
to REMARKS
W
7 '4d P
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES 0__N�G_
SPECIAL INSPECTOR P
,MQUIRED OC UPANCY GROUP
GAS 0 YES 0 _Z�
LINE PLAN CHECKED
NEW RESIDENTIAL r _,PY I
I NON-RESIDENTIAL M SIGN
FIADD
ALTER
1:1
n
DEMOLISH
EXCA.VA.TE
OR FILL
RETAINING
WALL
FENCE
( ......... x .......... Ft.)
RMUE
REPAIR
0-
PRE -MOVE
INSP.
swim
POOL
NUM13ER OF
DWELLING
UNITS
TA—TURE OF WORK TO BE DONE
1/1�lcfjj
k4s r I
X_ 4;el d
Plan Check No ............ .......
pSOPOIED TIAM
BUILDING
PLUMBING
to)
HEAT & GAS LINE
FENCE
AX3 27
*-4
%Q
I
N
SIGN
RETAINING WALL
SWIMMING POOL
Aj
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknoWled96 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
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compensation IMUrance.
ATTENTION
THIS PERMIT
AUTHORIZES
NOTE: Permit Limit One Year (Except DE51OLITIONS which
ONLY THE
WORK NOTED
In ninety do ED-IN BUILDINGS shall be wm.
sha I's compIV-,h,., yg "
pl,ted In six,
INSPECTION
DEPARTMENT
—SIGNATU (OWNER of
DATE SIGNED
e.
CITY OF
EDMONDS
NOIE: APPlicant Subject to'Plan Check Fee
PH 6-1107
-Fbls —Pennit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees. etc.) wII require separsto permission.
Valuation Fee Recelpt No.
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
6 Mr
FILM
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