680377.pdfgo
POSTED or; KROLL MAP NO.: PERMIT
NUMBER 680377
BUILDING DEPARTMENT Applicant Flu
05 -JOB ADDrSS
PERMIT APPLICATION Inside Heavy 'An
NjME (OR NAME OF BUSINESS) Line HEAR YARD SETBACK
-jTT—nEETsETBACk
SIDE YA D SETB�CK
Cd 6 a S' '�' I c)_�_ 0) 4:� 0
MAIIAn'40 ADIJkMMS U E LOT AICNA rTE
11e, /' 5 0
IS MBER YES V60
Y TELEruorija NU ;I
'A VARIAriC UAWA;"
CA
�71 �ol
CBS
i TELEPHONE NUMBER
EBB
TELE PHONE NUMBER
F LICENSE NUMBER CITY LICENSE NUALMU11
Description of Property (Show Below or 'Lttach Four copies)
ZREBIDENTIA
L
GAS
LINE
12rNEW
1
1:1
NON-RESIDENTIAL
D
SIGN
ADD
RETAINING
WALL
RDEMOLISH
ALTER
EJ
EXCAVATE
OR FILL
FENCE
( .......... x .......... Ft.)
F�PRE
REPAIR
F-1
-MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
I hereby acknowledge that I have read this application; that the in-
formation given In 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 conztmctt0n; and In doing the work authorized thereby, no person
will be employed in violation of the Labor Coda of the State of Washington
relating: to Workmans Compensation Insurance.
NOTE: Permit Umit One Year (Except DE5101ATIONS which
shall be completed in ninety days: 51OVED-IN BUILDINGS shall be com-
pleted in six months.)
�I—GNATURE (OWNEII, Ult Auz'NLJ DATE SIGNED
'_/T
NOTE: Applicant Subject to Plan Check Fee
_jjjfp Permit covers work to be done on Private Property U14�x-
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etcj win require separnte permission.
HEI T BUILDI G
PLOT pFj�APPROVED
STREET R/W
EXISTING STREET R/W ............ FT-
COMP. PLAN ST. R/W ............ FT-
DEFICIEN cy THIS PROPERTY
REUAIU!S
CKED BY
METER SIZE I SERVICE SIZE CLEARANCE
CHECKED BY
7 E—MARKS
TYPE CONNECTION
VERIFIED BY
PERO. TEST
PERMIT NUMBER
REMARKS
I= ZONE TYPE OF CONSTRUMION STREET IMPROVED
0 YES NO
SPECIAL 11413PECTOR REQUIRED
0 YES [] No
OCCUPANCY GROUP
PLAN CHECKED BY—
REU P
_rS
'P o -
vi 0
Plan Check No ............
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WOU-1
SWIMMING POOL
Dr-MOLITION
PRE -MOVE INSPECTION
i EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
IWORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PIC 6-1107
Valuation I Fee
I / S�. o r) I W�47_.'
APPLICATION APPROVAL
This application is not a pernilt, until
Signed by the Building official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
D - ATE
FILE
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