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8
ING DEPARTMENT I AppUcaut FW
iff APPLICAT101 Inside Heavy Lines
I'VIJULAA %'J9% "A
_AIAILWG ADV
F� NEW
MADD
ALTER
REPAIR
or
RESIDENTIJILL
NON-RESIDENTIAL
DEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
INSP.
DWELLING
UNITS
it
GAS
LINE
SIGN
RETAINING
WALL
PENCE
Mt.)
(J%-x ....
SWIM
POOL
?OSTED ON KROLL MAP NO.: PERMIT
NUMBER 68007#,r
OD ADDRESS
)IDE YARD SEMBACK
"r SETBACK
STREL
YEAR YARD SETBACK
—VA—CANTSM
USE ZONE
L AREA
13 YES 13 NO
HEIGHT
BUILDING AREA.
VARLOLNCE NUM13MR
PL40T PLAN "PROVED
STREET R/W
EN38TING STREET R/W DEFICIENCY TMS PROPERTY
COUP. PLAN ST. R/W ... . .. . ... FT,
REMARKS
tz
CHECKinn By
METER SIZE SERVICE SIZE CLEARANCE
CILEOXED BY
REMARKS
TYPE CONNECTION
VERIFIED BY
PERC. TEST
PERMIT NUMBER
[3 YES [3 NO
rinn Check No ............ .......
BUILDING
HEAT A GAS LINE
t
N
FENCE!
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
E3 YES C3 NO
9
Fee
No.
I hereby acknowledge that I have read this application; that the in- TOTAL AMOUNT DUE
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 end state laws regu. ATTENTION APPLICATION APPROVAL
lating construction; and in doing the work authortud 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 CompenfiattOn Insurance. AUTHORIZES
ONLY THE signed by the Building Official or his Dep-
e 0 *
n' that M
or the duty "a
s' ther-
,ndU at A AMOUNT
a PERM
RIZ
ot b a , J&Wo�
th are y no
Me of Washin
AUTilo
NLY
NOTE: Permit Limit One Your (Except DENIOIMJTION8 which WORK NOTED uty; and fees are paid, and receipt is ac-
RK
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com- knowledged in space provided.
pleted In six montila.)
D CT
DATE SIGNED INSPECTION __DIRE9T a BIG RE
It ME
DEPARTMENT
I
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee Pn 6-1107 c;L
This permit coven work to be done on private property ONLY.
Any construction an the public donnala (curbs, sidewalks, driveways, FILE
marquees, eAc.) will require separate permission. r
o A
t�l kt,
'-B'UILDING DEPARTMENT'
Applicant Fill
POSTED ON KROLL MAP NO.: PZRMrr
NUMBER
APPLICATION
Inside Heavy Lines
JOB ADDRESS
,PERMIT
IN AXE (OR NAME OF BUSINESS)
IV' /rA u it: A/ A A/
AT
Ili's
SIDE YARD, SETBACK
STREET SETBACK
REAR YARD HETISAWL
)BESS
Z
IV bf 1'
USE ZONE
LOT AREA
VACANT SITE
CITY
TELEPHONE NUMBER
YES NO
04
F
HEIGHT
BUILDING AREA,
VARIANCE NUMBER
NAME
PLOT PLAN APPROVED
ADDRESS
STREET BIW
EXISTING STREET R/W DEFICIENCY THIS PROPERTY
COMP. AN ST. R/W ..... .... XT.
CITY
TELEPHONE N—UhjBER
REMARKUP—L
Ell
Z
or
NEW
RESIDENTIAL
GAS
LINE
-RESIDENTIA
NON L
SIGN
ADD
DEMOLISH
RETAINING
WALL
EXCAVATE
Mv
FENCH...
ALTER
On FILL
Al
(.24..x Y4
REPAIR
PRE -MOVE
INSP.
swim
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
CHECKED BY
METER SIZE SERVICE SIZE CLEARANCE
CRECKE BY
RE�S
U.
TYPE CONNECTION
VERIFIED BY
PERO. TEST
PERMIT NUMBER
t
REMARKS
:T
FIRE ZONE TYPE OF CONSTRUCTION STREET 'IMPROVED,�
YES [jN16.
SPECIAL INSPECTOR REQUIRED
oc CUPANcy GROUP
[j YES NO
PLAN ULLECKED BY
REMARKS
!�7_j
Plan Check No .....................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
22
HEAT & GAS LINE
FENCE
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 In correct.; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply wiVa city and state laws regu-
lating construction; and In doing the work authorized thereby. no person
ATMNTION
will be employed In Violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTUORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shell be complated in ninety days; MOVED -IN BUILDINGS shall be com-
plated In six months.)
INSPECTION
SIGNATURE (OWNER OR AGENT)
DATE SIGNED
r
A/11
DEPARTMENT
f"11111V nirl.
Valuation Fee
00
:;IA
APPLICATION APPROVAL
This application is not a permit until. :i�!
signed by the Building Official or his Dep- "I
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
Dlg7
EDMONDS
NOTE: Applicant Sitbicrt to Plan Check Fee PR 0-1107
This Permit covers work to be done an private property ONIY.
Any construction on the public domain (curbso sidawalkso driveways,
marquacs, etc.) will require separate permission. INSPECTOR K
ell.
I