680187.pdfPOSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicantm NUMBER 680187
!I Inside Heavy Lin 8 JOB ADDRESS
PERMIT APPLICATION
F71-
I ! gi NAME OF BUSINESS)
-MAILING AJQDRESS
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1
—VACANT
0
97�
UsEeeo�E
LUT A�A 11 SITE
13 YES 13 No
-6-1TY
FE—LEPHONM NUMBER
R_ V'�-7
A.
"EIGHT
BUILDING AREA VARIANCE NUMBER
NAME
PLOT PLAN APPROVEr
ADDRESS
STREET RIW
EXISTING STREET R/W ........... FT. DEFICIENCY THIS PROPERTY
CITY TELEPHONE NUMBER
COUP. PLAN ST. R/W ........ ... FT- .......... IrT.
0
REMARKS
NAME
ADDRESS
D BY
MBRR
1
z
8
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
STATE LICENSE NUMBER
fjiwx LICENSE NUMBER
.2;23�01-377,T
I
REMARKS
�Legal Description of Property (Show 13�1_oWor Attach Four Copies)
TYPE CONNECTION
VERIFIED BY
I
z
V
PERO. TEST
PERMIT NUMBER
RESIDENTIAL
GAS
LINE
NEW
NON-RESIDENTIAL
SIGN
El---
RETAINING
WALL
ALTER
DEMOLISH
EXCAVATE
OR FILL
FENCE
( x Ft.)
.......... ..........
REPAIR
Q
PRE -MOVE
INSP.
SWIM
POOL
iUMBER OF STORIES
'NUMBER OF
DWELLING
UNITS
[] YES
TYPE
0
11=9
jZa-44(_',,, 4h-6-VAJ
Plan Check No ............ . .......
PROPOSED USE V
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUM31
BEAT & GA� 1,14
FENCE
t
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-
ATTENTION
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 PERMT
relating to Workmeirs Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DE51OLITIONS which
WORK NOTED
shall be completed in ninety days; MOVED-YW HUHMINGS shall be oom-
pleted In six months.)
SIGNATURE (OWNER OR AGENT)
NEI)
INSPECTION
DEPARTMENT
I?
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PH 0-1107
This Perrolt covers work to be done an private Property ONLY.
Any oonstructim on the public dornabe (curbs, sidewalks, driveways,
marquees, ate.) will require separate permission.
0 YES 0 NO
Valuation I Fee
.3. at
No.
zq,5-o
'VAL
APPLICATION APPRO
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.
'. t�r �
FILE
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