680342.pdfPOSTED 014 KROLL MAP NO,: PERMIT
B 680342 i
BUILDING DEPARTMENT Applicant Fill
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Inside Heavy Lines
J JOB ADDRE133
1-7
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS) Q
SIDE Y EET SETBAC D SETBACK
ARD BET13ACK STU REAR YAR
XADAN RESS
UBE ZONE LOT AREA I VACANT BITE
LEPRONE NUMBIL�R U ri z
IT a I t
A HEIGHT BUILDING AREA VARIANCE NUMB it A.
MAY,
N Im
AME
PLOT PLAN APPROVED
STREET R/W
TELEPHONE NUMBER EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ ITT.
REMARKir
ADDRESS
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CHECKED BY
TELEPHONE NUMBER
UETER 8 E ICLEARANCE CHECKED BY
CITY LICENSE NUMBER
STATE LICENSE NUMBER
—IffM—ARKS
LO al Description of Property (Show Below or Attach Four Copies)
TYPE CONNECTION VERIFIED BY
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PERC. TEST PERMIT NUMBER
REMARKS
FIRM ZONE TYPE OF CONSTRUCTION STREET IMPROVED
[3 YES 0 NO
SPECIAT MOTOR REQUIRED OCCUPANCY GROUP
GAS [3 YES [1:
NEW RESIDENTIAL El LINE PLAN CHECKED BY
NON-RESIDENTLILL E] SIGN
RETAINING REMARKS
ElDEMOLISH El WALL
ElALTER EXCAVATE PENCE
0 OR FILL D I .......... x . ........ Ft.)
El REPAIR E3 PRE -MOVE swim
INSP. 0 POOL
NUM13ER OF STORIES IWAUSMn OF
DWELLING
UNITS
NATURE OF WORK TO BE DO
Valuation FOB Receipt No.
Plan Check No ..... ..............
PROPOSED USE
BUILDING
C�-_o
PLOT PLAN (Indi cato Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
N
RETAINING WALL
SWIMM NG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that the In-
formation given Is correct; and that I am the Owner, or the duly author.
Ized ngent of the owner. I agree to comply with city and state laws regu-
ATMNTION
APPLICATION APPROVAL
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 PEnMIT
This application is not a permit until
relaUng to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building OffIcial or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
shall be completed In ninety days: MOVED -IN BUILDINGS shall be com-
Imowledged in space provided.
pleted In six months.)
SIGNATURE (OWNER Olt AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
D OR'S 81 1
W
Ll�_M
CITY OF
EDMONDS
NOA APPlicant Subject to Plan Check Fee
rR 6-1107
This Permit covcr� work to be done on, private property ONLY.
Amy construction m the public domain (curbs, sidewalks, driveways,
FILE
marquecs, etc.) will require separate permission.
I
RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
(Rough)
P.J
Frame
Furnaci;- & Fuel Lines
4V
final
RECORD OF INSPECTIONS
,5,ted
Date Pa
10/
Drainage
Sewer
Parking
Landscaping
Fire Dept.