680211.pdfPOSTED ON KROLL MAP NO.; PERMIT 68U21
I
BUILDING DEPARTMENT Applicant Fill
NUM13ER
PERMIT APPLICATION Inside Heavy Lines
JOB ADDIIESS
BUSINESS)
�
;Z A/,;Z / q
NAME (OR NAME OF
&Y,
81DE Alto SETBACK
_17
STREET SETBACK
r
REMs YARD SETBACK
Q. ,,,
-f-&A
MAILING ADDRESS
VA ANT SITE
Sao 6- Z_ y av
USE
LOT AREA
YES NO
Y
--I TELEPHONE NUMBI!:R
CITY
0 r.
HEIGHT
BU ILDING AREA
VARIANCE NUMB
04
NAME
—FL—OTPLILN APPROVED
ADDRESS
A�
STREET R/W
EXISTING STREET R/W k—K.LFT. DEFICIENCY THIS PROPERTY
CITY �PHONE�NUMBER
PLAN ST. R/W.&O.F'r. FT.
COMP.
REMARKS
NAM
Driveway slopes not to exceed those
indicated on Standard Drawing #103.
ADDRESS
Z
V
___7CHECKED
13Y
E4
CITY
TELEPHONE NUM33ER
i
STATE LICENSE NUMBER
da-5 — 0 / — .5-1 4�6
CITY LICENSE NUMBER
1
Legal Description of Property (Show Below or Attach Four Copies)
:3
TYPE CONNECTION
VERIFIE
L04*AE 13A 4.- 1, A.-6
PERMITk�TBER
4-
REMARKS W
0
TYPE U ON STREET IMPROVED
077;y 1 [:] YES NO
SPECIAL IN13PECT r(EQUIRED
0 YES ;Z0
OCCUPANCY GROUP
G S
NEW LN RESIDENTIAL LINE
1 1:1 NON-RESIDENTIAL I F� SIGN
ElADD RETAINING
EDDEMOLISH WALL
ALTER EXCAVATE FENCE
OR FILL F ( .......... x .......... Ft.)
REPAIR PRE -MOVE swim
M INSP. POOL
PLAN CHECKED By
REMARKS
NUMBER OF STORIES
_E
NUMB R OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
4- I,= Ad Rycrl —
I
Valuation
Fee
Receipt N o.
c k N 0
Plan Check No ............ . .......
P a n It e
D G
BUILDING
B U IL
N G
PLUMWNG
P L U M
G A S L
HEAT & GAS LINE
I-I E A T
r E E
FENCE
t
SIGN
41 G
NC
RETAINING WALL
IM n Po
wimMING POOL
s SW 3 N
L TIC
DEMOLITION
I rMo I N
RE -MOVE INSPECTION
P - 0 IN
P M V
EXCAVATION OR FILL
XC V TIC
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given li 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-
luting construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workman's Compensation Insurance.
NOTE: Permit Limit One Yeor (Except DE31OLITIONS which
shall be comleted in ninety days; J%IOVED-IN BUILDINGS shall be wm-
pleted in Wmonths.)
/_7 —6 6
)(OTE: Applicant S'ubject to Plan Check Fee
This Perralt covers work to be done on Private property ONLY.
Any coustrUellon on the public domain (curbs, sidewalks, driveways,
marquess, etc.) will require separate permission.
ATTENTION
TIUS PER511T
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR G-1107
C;21
I
aw
APPLICATION APPROVAL`
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.
'. -;:7 �
FILE