680260.pdfPOSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant M NUMBER 680260
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PERMIT APPLICATION Inside Heavy Lines —J5B—AzDDRi`8DS
NAME (OR NAME OF BUSINESS) :2, e) 9 SETBACK
SIDE YARD SETBACK I STREET SETBACK REAR YARD
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MAILING ADDRESS 211-k MAW-) ;r,)
USE ZONE LOT AREA VXUM'l SITU
F / '?_ ) C, r/-/ %YES No ?.5
CITY TELEPHONE NUMBER
HEIGHT 13UILDING AREA VARIANCE NUMBER ;4
NAME I —
PLOT PLAN APPROVED
ADDRESS
STREET R1W
CITY TELEPHONE NUMBER EXISTING STREET R/W ............ FT. DEFICIENCY THI PROPERTY
COMP. PLAN ST. R/W ........... X-r. ............ FT. 0
NAME Lfl t 8' Eql REMARKS I
Driveway slopes not to ex eed those
4 4Z indicated on Standard Drawing #103.
ADDRESS
CHECKED BY
CITY TELEPHONE NUM13ER
METER SIZE SERVICE SIZE CLEARANCE CHEW BY
—3 y (
STATE LICENSE NUMBER CITY LICENSE UMBER
Legal Description Of Property (Show Below or Attach Four Copies)
7— CMM Y /?k TYPE CONNEqn_0N BY
U:
0 _tAdo 0_"jV PERC. TES'q T UMBER
REMARKS
0 FIRE�rZO TYPE OF CONS RUCTIO STREET IMPROVED
[j YES [3 NO
spEaRL INSPEC R REQUr—RED JOCCUPANCY GROUP
GAS 0 YES TN 0
P] NEW RESIDENTIAL L NE PLAN CHECKED BY
1 9 NON-RESIDENTIAL SIGN
ADD RETAINING REMARKS
E] DEMOLISH WALL
ElALTER EXCAVATE PENCE
1:1 OR FULL ( ........ . x .......... Ft.)
El REPAIR PRE -MOVE swim
INSP. POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS.
NATURE OF WORK TO BE DONE
Valuation Fee Receipt No.
Plan Check No ............. .......
PROPOSED USE
BUILDING
PLOT PLAN (indicate But Betpacks, abutting streets)
PLUMBING
BEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE.MOVB 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 am the owner, or the duty 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 PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE5101ATIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; 111OVED-IN BUILDINGS shall be com.
plated In six months.)
TI—ONATURE (OWNER Oft AGENT)
D TE SIGNED
INSPECTION
IL I
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Sitbject to Plan Check- Fee
Pn 0-1107
This Permit covers work to be done an private property ONLY.
Any construction an the public domain (carba, sidewalks, driveways,
marquees, etc.) will nquire separate permission.
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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-
knowledged in space provided.
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