680195.pdfSTEC ON KROLL MAP NO-: PERMIT 680195
BUILDING DEPARTMENT Applicant Fill
"MR
CATION Udde Heavy Lines
PERMIT APPLI I
ADDRESS
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r7 s
(OR NAME OF 33U 1)
e &r'r ju 111LIM C Al
-=- ICK 3ACK
REAn �ARD 13ETBACE
SIDE YARD BETBAUK sTpzwr a BA A,
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10
79M
ZTG__X]DDRES8
-7
USEL-2KINZ LOT AREA VACANTT Or=
WNIAZIPRONA NUMBER
[3 YES [3 NO
(J� �
CITY
i�' CF 94 0 Iq (,bfi U
HEIGHT FING AREA VARL&NcE NUMBER
Ce5 1
NAME
PLOT PLAN APPROVED
ADDRESS
STREET RIW
EXISTING STREET R/W DEFICIENCY THIS PROPERTY
CITY UMBER
COUP. PLAN ST. R/W
WMARKS
-1
NAMIR
42 tJ fY W;I�f
imeway slwps nnt -ppa thnsp
indicated on Standar d Drawing #103.
rp (.4 ) In
b
0 Af jo L or '-A�m I
CITY
TELEPHONE NUMBBM
8
METER SIZE 13EPAVgICE SIZE CLEARANCE Clqn
A�1113 By
-8-T—ATE LICENSE NUMBER
CITY LICENSE 1411MISJUJM
-5 4 1
I
Leglu Description or Property (show Below or Attach Four Copies)
TYPE CONNECTION
BY
77 =----
z
_FTERC. TEST
REMARK13
FIRE &qA916 TypZ Oj:C UOTION STREET IMPROVED
0 YES [3 NO
SPECULL INSPECTOR REQUIRED
ow cup
13YES
GAS
RESIDENTULL LINE
_C_H_EC_KE_9BT__
NEW
E.
PLAN
ElNON-REWDENTIAL SIGI;
REMARKS
"W RETAU41NG
nDEMOLIGH WALL
F-1 ALTER EXCAVATE FENCE
F1 OR FIM E] ......... Ft.)
REPAIR PRE -MOVE SWIM
INSP. POOL
NUMBER OF
DWELLING
UNITS
Fee
Mn Check
BUILDING
10.1 0,
PLOT PLAN (Inalc&te pwjujug natu,,", abutting streets)
PLUN33ING
Cow&
13EAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
K'
PRE -MOVE INSPECTION
EXCAVATION OR FILI,
TOTAL AMOUNT DUE
L'
I hereby acknowledge that I have read this application; that the In-
formation given to 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 rOgU
ATTENTION
APPLICATION APPROW
lattng construction; and in doing the work authorized thereby. no person
In Violation of the Labor Code Of the State Of Washington
TM PERMIT
This application is not a pernilt, until
will be employed
relating to WorkmazVe Compensation Insurance.
AUTHOREZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
awl be completed In MOv7M_1N BUILDINGS shall be oorn-
M"'e
ImowIedged in space provided.
PIC In mix mon �
III RE DAWE ulutizu
RAG= )V
INSPECTION
8 of
1(7Y/ 6 W
DEPARTMENT
A 4,K 6
CITY OF
11
1 EDMONDS
DATE
NOTE: Appfi"nt Subject to Plan Check Ae
pit 6.1161
This permit coven work to be done an private property ONLY.
Amy oonstmcilOu On the public domain (Curbs, sidewalks, driveways,
marquees, a".) win require separate pervAssion.
FILM
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