680362.pdfBUILDING DEPARTMENT ApplIcant Fill
PERMIT APPLICATION inside Heavy Lines
NAME (OR NAME OF BUSINESS)
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4C, H A (Z "E S
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ADDRESS
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NUMBER
ITELEPHONE
NAME
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ADDRESS
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CITY
TELEPHONE NUTIBER
NAME
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ADDRESS
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CITY
TELEPHONE NUMBER
51o9
STATE LICENSE NUMBER
uiry LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
41
GAS
NEW RESIDENTIAL LINE
I
NON-RESIDENTIAL F� SIGN
ADD RETAINING
F-1 DEMOLISH M WALL
ElALTER EXCAVATE FENCE
M OR FILL ( x Ft.)
.......... ..........
REPAIR PRE -MOVE swim
n INSP. El POOL
NUM13ER OF STORIES
NUMBE R OF
EF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
PROPOSED USE
e� fa,�% A P(n L
PLOT FLAN (inclicato Building setbacKs, abutting streets)
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I hereby acknowledge that I have read this application; that the in-
formation given Is 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.
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 Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVEDAN BUILDINGS shall be com-
nleted.Ln six months.) I
op
'—NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate parmlssion.
ROLL MAP NO.: PERMIT
55 1 NUMBER 680362
IlIq — rl 1� — P� . 60,0�
IETHACK STREET SETBACK HEAR YARD SEW13ACK
LOT AREA VACANT BITE
VC )s
0 YES P(�!o
REIGHT
muiuDING AREA
VARIANCE 14UMBER
;w
FLOT —PLAN APPROVED
STREET R/W
EXISTING STREET R/W ........... YT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT.
............ FT.
REMARKS
CHECKED BY
METER SIZE SERVICE SIZE
CLEARANCE
BY
I
ICHECKED
REMARKS
TYPE CONNECTION
VERIFIED BY
PERO. TEST
PERMIT NUMBER
REMARKS
FIRE gWE TYPE OF CONSTRUCTION
_:Z� I J�;— V
STREET IMPROVED
I [] YES E3 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
0 YES KNO
PLAN CHECKED
REMARKS
Valuation
Plan Check No .....................
No.
BUILDING V-�' �1,.D_o a /9100
PLUMBING 6*� 3 4". !P6
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE 1A t�-. 5-0
ATMNTION APPLICATION APPR03VAM
THIS PERMIT This application Is not a permit until
AUTHORIZES
ONLY THE signed by the Building Official or his Dep-
WORK NOTED uty; and fees are paid, and receipt is ac-
lmowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
4
FILE