680215.pdfIs
PERMIT
11 POSTED ON KROLL MAP NO.:
NUMBER 680215
'BUILDING DEPARTMENT Applicant Fill
inside Heavy Lines joB �ADDREsq_ CV
PERMIT APPLICATION
BUSINESS)
NAME (OR NAM OF c;?- 17
BETBAC AR YARD SETBACK
SIDE YARD SETBACK STREE K
RE
- - - - - - - - - - - - - - - VACANT 81-TIM
USE ZONE LOT AREA
Z7
affMBER 1 1 [3 YES 0
CITY
—ii—El—GHT 0jj,`DjNG AREA VARIANCE NUMN—Elt N
3
�NAME
LOT PLAN APPROVED
C -Ine
STREET R1W
TELEP&WAN NUMBER EXISTING STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
01 COMP. PLAN ST. R/W ............ FT- ....... .... FT.
rS;� 4— 74 REMARKS
NAME
CHECKED BY
77,
/xj
CHECKED BY
Z C) METER SIZE SERVICE SIZE CLEARANCE
8-
..,g,
STATE Llclu4bia NUM13WIt CITY LICENSE NUMBN"
REMARKS
Legal Description of Property kbnow below or Attach Four Copies)
TYPE CONNECTION VERIFIED by
PERC. TEST PERMIT NUMBER
REMARKS
0 FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
ij YES 13 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
GAS Cj YES 11 NO
NEW RESIDENTIAL L'INE PLAN CHECKED BY
NON-RESIDENTIAL SIGN
ADD RETAINING REMARKS
DEMOLISH WALL
ALTER EXCAVATE FENCE
D OR FILL ( .......... x .......... Ft.)
PRE -MOVE swim
REPAIR IN8P. POOL
F
:8 NUMBER
OF
DWELLING
UNITS
Plan Check No .....................
USE
PROPOSED
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUM33ING
BEAT & GAS LINE
PENCE
t
SIGN
N
RETAINING WALL
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 to correct; and that I anot the owner. or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu-
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
relating to Workmens Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be oom.
pleted In six
I
2�lp
NOTE: cant Subject ir Plan Check Fee
This Pernift covers work to be done cot private property ONLY.
Any construction an the public dommin (curbs, sidewalks, drlvcwlLYD,
marquess, etc.) will require separate permission,
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
Valuation I Fee I Receipt No.
�� I 1;,: 0 0
APPLICATION APPROVAL
This application is not a permit unM
signed by the Building official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
FILE