680374.pdf------ ----
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POSTED -ON KROLL
MAP NO-:
PERMIT
680374.
BUILDING DEPARTMENT
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Applicant Fill,
NUMBER
PERMIT APPLICATION
Inside Heavy Lines
JOB
ADDRE138
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NAME (OR NAME OF IJUSINESS)
BL917DAU" TREET SETBACK
ACK
REAR YARD SETBACK
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SIDE YARD
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MAILING AD
USE
LOT AREA
VACANT SITE
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TELEPHONE NUMBER
!ATE LICENSE NUMBER
CITY LICENSE NUMBER
3gal Description of Property (Show Below or Attach Four cop! so I
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RESIDENTIAL n LINE
ElNEW
NON-RESIDENTIAL SIGN
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RETAINING
ElDEMOLISH WALL
ElALTER
EXCAVATE PENCE
OR FILL (.7.Ax Ft.)
REPAIR
PRE -MOVE swim
F-1 INSP. POOL
NUMBE F
DWELLING
UNITS
TA-TURE _0F WORK TO 33E DONE
,06 1L r1j, J) Y-- n �� A I'D J'56'111 6
LOT PLTN_ZPPROVED
REET R/W ........... YT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... XT-
............
tEMARKS
11 CIIECKPD 13Y
METER. E ;E CLEARANCE
BY
I
ICHECKED
REMARKS
0
TYPE CONNECTION
VEIUFIED BY
PERC. TEST
PERMIT NUMBER
1_'1
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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YES _ qxgG
SPECIAL INSPECTOR �-UIREG
OCCUPANCY GROUP
y 'ES
PLAN CIIJICKED14y_
I'lan Check No ...................
1-94.
PROP09ED UNN
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & 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 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-
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 IIERMIT
relating to Workmen's Compensation Innurance.
AUTHORIZES
ONLY TILE
NOTE: Permit Ittimit One Year (Except DEMOLITIONS which
AVORR NOTED
shall be completed In ninety days; DIOVED-IN BUILDINGS shall be com.
pleted In six months.)
INSPECTION
3IGNATURE (OWNER OR AGENT)
DATE SIGNED
DEPARTMENT
CITY OF
�NOTE:
EDMONDS
7�
APPli"lit SUbject to Plan Check Fcc
PR 6-1107
This rermit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permle3lon.
Valuation I Fee
it 17
1
1�0
0 0 V*6
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.
_13-
FILL
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