680411.pdfC
?oSTED ON KROLL MAP NO-: 1prAMT.
NUMBER 680411
BUILDING -DEPARTMENT 11111111416 HCSIVY Lines JOB ADDRESS
PERMIT APPLICATION
UILDIN
NAME (OR NAME OF BUSINESS)
SIDE YARD SETBACK STREET BET13ACK REAR YARD SETBACK
SK 1P S r 0 P_ 6-S
-7- NE LOT AREA VACA24W OrNAM
11C— , 5 0
CITY MXPHONE NUMBER C YES 13 NO
L: iq HEIGHT BUILDING AREA I VARIANCE NUMBER
L: 19 M
F
NAME
PLOT PLAN APPROVED
DRESS
STREET R/W
CITY E PHONE NUMBER EXISTING STREET R/W ....... .... FT. DEFICIENCY THIS PROPERTY
TN COMP. PLAN ST. R/W ........... JPT- ...........
REMARKS
NAME
NC—LONACME 5lu-14,1 C01
ADDRESS
/ .2- C 5 T4,4 9 6 VC, BY
CITY ICALL&WPHONE NUMISFAt
5C-,4 T7-Z- C-,, W/t/, _r, 21-0 700 METER SIZE SERVICE SIZE CLEARANCE CHECKED By
STATE —LICENSE NUMBER Of LICENSE NUMBER
[A
r
2- 2 '4�- -5- REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
TYPE CONNECTION VERIFIED BY
PERO. TEST PERMIT NUMBER
REMARKS
D ZONE TYPE OF CONSTRUCTION STREET IMPROVED
13 YES [3 ITO
SPECIAL IN13PECTOR REQUIRED OCCUPANCY GROUP
GAS [3 YES [3 NO
NEW RESIDENTIAL LINE PLAN CHECKED BY
IAL
NON-RESIDENT j SIGN
RETAINING REMARKS
El DEMOLISH WALL signs that have fladhingg blinkingg Or
ALTER EXCAVATE FENCE
OR FILL .......... Ft.)
PRE -MOVE swim moving lights must be turned off by 11:30 PE
REPAIR INSP. POOL
NUMBER or
DWELLING AE
UNITS
NATURE OF WOjM —TO 13E DONE
veauation Fee
Plan Check No ................ ...
PROPOSED USE
BUILDING
—FL—OT PLAN (Indicate Building setbacks, abutting streets) PLUMBING
HEAT & GAS LINE
FENCE
t SIGN 00
N C-- IL S"Q
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR BILL
TOTAL AMOUNT DUE
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 -
lead agent of the owner. I agree to comply with city and state laws regu- ATTENTION APPLICATION APPRO L
letting 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 This application is not a pernilt until
relating to Workman's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
NOTE: Permit Umit One Your (Except DE51OUTIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
shalt be completed in ninety days; MOVED -IN BUILDINGS shall be com- knowledged in space providecL
pleted In six months.) INSPECTION
�SJGNATURE (OWNER OR AGENT) DATE SIGNED DEPARTMENT DIRECTO TURE
/If� I C/ // 0/6 CUY OF DATE
NOTE: Applicant Subject to Plan Check Fee EDMONDS
PR 6-2107
TWO Permit coven work to be done an private property ONLY.
,WW onaggruction no the public domain (curbs, sidewalks, driveways, ram
nIffinufts, eto.) will require separate perrodstlon.
I � Ip