680116.pdfPOFTED ON KROLL MAP NO.: PERMIT
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NUMBER 680116
UILDING DEPARTMENT
APPLIcant FIR
Inside Heavy Lines JOB ADDRESS
PERMIT APPLICATION
Flo
NAgME (OR NAMID OF BUSINESS)
SIDE YARD BET13ACK REAR YARD SETBACK
0
STREET SETBACK
/10 M ;z
USM ZONE LOT AREA ANT SITE
0 NO
CITY TELEPHONE NUMB YES
HEIGHT 13ULLDING AREA VARIANCE NUMBER ;6
IFjg-? 7340
NAME
PLOT PLAN APPROVED
_A75DRESS
STREET R1W
ICIENCY THIS PROPERTY
CITY TELEPHONE NUMBER EXISTING STREET R/ .-...FT. DEF
PLAN ST. R;/ ..... FT.
COUP. A') / . ............ PT . rz
REMARKS
'OF
NAMM
/f 40 t3_
0
C, 17 .7* L e
-.T 4L2 b-T e 11
ADDRESS z
/ 26 D BY
CITY TELEPHONE NUMBER
METER SIZE I BERVICIP SIZE CLEARANCE 7�
pt, 2-
C STATE LICENSE NUMBER CITY LICENSE NUMBNkt
ct
REILARKS
Legal Description of Property (Show Below or Attach Four Copies)
a TYPE CONNECTION vEF4ME
D BY
PERO. TEST PERMIT NUMBER
P REMARKS
-S?20 17 CIO -
[j YES [3 NO
RESIDENTIAL
GAS
LIND
C] YES 13 NO
JO.
NEW
PLAN CHECKED BY
NON-RESIDENTIAL
SIGN
J.-D
0
RETAINING
WAIJ
REMARKS
DEMOLISH
0 ALTER EXCAVATE PENCE
El El Ft.)
OR FILL ( ........ . X ..........
REPAIR PRE -MOVE
INSP.
swim
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
—NATURE OF WORK TO BE.DONE
Valuation
Fee
Receipt No.
Plan Check No .....................
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building Setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
N
RETAINING WALL
f
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-
ized agent of the owner. I agree to comply with city and state laws regu-
ArTENTION
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 Insurance.
AUTHORIZES
Sign ed by the Building official or his Dep-
NOTE: Permit Limit One Year (Except DE31OLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
lmowledged in space provided.
pleted In six months.)
SIGNATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
—b-IR—EC 0 'J3 BIG
CITY OF
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on, the public domain (curbs, sidewalks. drlverways,
marquees, age.) will require separate permission.
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