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j ':�OLL MAI? NO.:
FORM= 71 PERMIT
ING WARTMENT Applicant IFIH NUMBER
]Inside Heavy Lines JOB AD )RESS
APPLICATION
�w R NAME OF BUSINESS)
SIDE YAj7I SETBACK STREFT EET13ACK REAR YARD SETI]Au�
J
A' VACANT SITIG
USE ZONE LOT ARE
CE3 YES [3 N
TNLEMONEI NUMBER
HEIGHT BUILDING jaWA, VARIANCE 14UAIO
24AME
PLOT PLAN APPROVED
Q_ �ALA5,0 A)
STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
'ABLEPHON NUMBER
COMP. PLAN ST. R/W ............ FT-
SLL REMARKS
NAME
Z
as
5NURED �By
E NUM13ER
<SL1_-:S. METER SIZE SERVICE SIZE CLEARANCE FHECKED BY
CITY LICENSE NUMBER
STATE LICENSW 14U�Dc`"
REMARKS
how Below or Attach Four Copies)
�.Legal Description of Property (S
TYPE CONNECTION
L.A VERIFIED BY
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fZ_4 J�) RC. TEST PERMIT NUMBER 4:
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6A 1 IQ
kin, REMARKS
6- 0 �Aj Aj.
TREET IMPROVED
FIRE ZONE TYPE OF CONSTRUCTION IS
14 0 YES [3 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
GAS [3 YES 11 NO
NEW RESIDENTIAL LINE PLAN CHECKED BY
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NON-RESIDENTIA SIGN
ADD RETAINING REMARKS
DEMOLISH WALL
Fur FENCE
Ua ALTER EXCAVATE
1:1 OR FILL I- ........ x .......... FL.)
REPAIR PRE -MOVE SWIM
1:1 INSP. POOL
NUMBER OF STO NU or
DWELLING
UNITS
—gA—TUREOF WORK TO BE DONE
C, -ry% l. 112 (a C_ . Valuation Fee Receipt No. .
Plan Check No .....................
PROPOSED USE
BUILDING 0 V3 00
QC-) r o, Ci A�\ ,
PLAN (Indicate Building setcackG, abutting streets) PLUMBING
ITEAT & GAS LINE
FENCE
t SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE 5
I hereby acknowledge that I have read this application; that the In- D 0
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- ATTENT11ON APPLICATION APPROVAL
lating construction; d In doing the work authorized thereby, no person
will be c o ed I Iola Ion of the Labor Code of the State of Washington This PERMIT This application is not a permit until
relating to W r on's ompensation Insurance. AUTHORIZES signed by the Building Official or his Dep-
ONLY THE uty; and fees are paid, and receipt is ac-
NOT er, it 'i it one Year (Except DE31OLITIONS which WORK NOTED
shall C mpli ed t nety dayy'lp� OVED-XN A�ILDINOS shall be com- knowledged In space provided.
e INSPECTION DIRECTOR'S SIGN41�
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rUrovNE OR A DATE SIGNED DEPARTMENT
lie
A 11 ,
CITY 0
EDMONDS DATE
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This permit covers work to be done on private property ONLY.
n the public domain (curbs, sidewalks, driveways, FILE
Any construction 0, ep%rate permission.
murquees ate.) will require 8
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