680026.pdfI
UILDING DIPARTMENT
ATION Applicant Fffl
PERMIT APPLIC Inside Heavy Lines
;q (on NAMM OF BUSINESS)
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WAILING ADDRE..
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OITT TELEPHONE NUUNER
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ED ON KROLL MAP NO-: FEMPT '68U
/ NVUBER
LDDRESS
5-5-0 - 5--
YARD SETBACK I STREET BETIJAC AR YAR
1�
0
VACANT BITE
13 YES 13 NO
VARIANCE
8TREM R/W
EXISTING STREET R/W
DEFICIENCY THI13 PROPERTY
ELEPHONE NUMBER
COMP. PLAN ST. R/W
.......... FT.
REMARKS
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ADDRESS
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NUMBER
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1TELEPHONE
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KrAl
METER SIZE SERVICE
SIZE
CLEARANCE
CHECKED BY
ft5TATE LICENSE NUMBER CITY'LICEN NU
REMARKS
Legal Description or rroparty (Show Below or Attach Four copies)
TYPE CONNECTION
VERIFIED BY
PERO. TEST
PERIM NUMBER
REMARKS
FIRE ZONE TYPE OF C ONSTRUCrrIOR STREET IMPROVED
13 YES [3 NO
SPECIAL IZ UWE REQUIRED GROUP
E3 YES 13 NO
BY
JOCCUPANCY
GAS
RESIDENTIAL El LINE
PLAN CHECKED
NON-RESIDENTIAL SIGN
RETAINING
WALL
REMARKS
DEMOLISH
This PerMit
for foundation onlYo
ElALTER EXCAVATE PENCE
0 OR FILL El ( x . ........ Ft.)
........ .
1-25-68 A. Ellin
REPAIR PRE -MOVE SWIM
INSP. POOL
NUMBER OF
DWELLING
UNITS
NATURE OF WOjN —TO BE DONE
valuation
Fee
—Jqb
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0
Plan Check No .................
PROPOSED UBE
BUILDING
;1A ofia
& Fft
OL
PLOT PLAN qmcate Building WeIPICHN, abutting Streets)
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
RWAINING WALL
SWIMMING POOL
OLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
F sri. 9-1)
I hereby acknowledge that I have read this application; that the In-
formation given is correct; and that I am the owner, or the duty author-
tzed agent of the owner. I agree to comply with city and state laws regu.
ATTENTION
APPLICATION APPROVAL
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
This application is not a permit until
relating to Workmen's Compensation InAtuZZ100-
AUTHORIZES
signed by the Building official or his Dep-
NOW Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
completed in ninety days; MOVED -IN BUILDINGS shall be com-
knowledged in space provided.
t a mon . - -
IG URE (0 R A T) D IGNED
INSPECTION
DIRE OR'S SIGNATURE
DEPARTMEI-Vr
C ITY OF
EDMONDS
DATE�
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
Permit covers work to be done an private Property ONLY.
on the public domain (curb$, sidewalks, driveways,
Any constructIon
marquees, etc.) will require separate Permission -
9
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