680410.pdfBUILDING DEPA 'RTMENT
PERMIT APPLICATION
Applicant FM
Inside Heavy Lines jOB
POSTED ON KROLL MAP NO-: PERMIT
N'UMBER 680410
71
ADDREss
92� 4.4%
NJ BUSINTE
PW
SIDE YARD SETBACK STREET SETBACK REAR YARI SETBACK
777 A-VII
USE ZONE LOT AREA
YES ),fto
-12�ITJNG ADDRESS
CITY
ry-1 fo ct < Lo
VE—CFP—HONUNUMBER
7 3 C)
HEIGHT BUILDING AREA. VARIANCM NUM"Jun
NAME
PLOT PLAN "PROVED
ADDRESS
Wt -4e
STREET R/W
EXISTING STREET R/W DEFICIENCY THIS PROPERTY
COMP. PLAN ST. .......... XT.
—CIT—Y TELEPHONE NUMBER
REMARKS
NAM10
wl
Z
f
C4
CHECKED BY
CITY
WSL"Nklilurt.Ai U ER
:MBER
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
STATE LICENSE NUMBER
REMARKS
—Legal Description of Property (Show Below or Attach Four Copies)
Ire 4 o 1 11 71) P - 08 Ke, I
TYPE CONNECTION
VERIFIED BY
L *7 0 X .3 0 - 7- -72 — Aj 4):�
PERO. TEST
PERMIT NUM13ER
Al -1 C 3- E Al 40
3
REMARKS
FIRE ZONE. TYPE OF C9WRUCTIOrj STREET IMPROVED
[3 YES [3 I -TO
)R REQUIRED
YES 0
_V�N
OCCUPANCY GROUP
GAS
RESIDENTIAL LINE
NEW
NON-RESIDENTIAL SIGN
1 1:1 1-1
ADD RETAINING
DEMOLISH WALL
ALTER EXCAVATE PENCE
OR FILL ( ....... x .......... Ft.)
PLAN CHECKED BY
Ali
REMARKS
PRE -MOVE SWIM
REPAIR INSP. POOL
NUMBER OF
DWELLING
UNITS
Z
rian Check
PROPOSED USE BUILDING
13_CD tqvoZt-�, j
Q PLOT PLAN (Indicate Building setbacly, abuttlng streets) PLUMBING
04 4--awdlL & %
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby salt owledge, 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- ATTENTXON
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 Workman's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Umit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days: MOVED -IN BUILDINGS shall be oom.
plated In six months.)
SIGNATURE (OWNER UR AGENT) DATE SIGNED INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks# driveways,
ouLnueass etc,) will require separate permission.
Fee
I -All
APPLICATION APPROVAL
This application is not a pernift until
signed by the Building official or his Dep-
uty; and fees are paid, and receipt is ac-
Ifnewledged in space provided.
DIRECTOWS SIGNATURE
FILE
N6
. M