680469.pdf........... . .... .. - -----
POSTED ON KROLL MAP NO.: T
PERMI
BUILDING DEPARTMENT Applicant Flu NUMBER
- I i0r. A
Rpm
PERMIT APPLICATION inside Heavy 71nels JOB ADORE
INAME (OR NAME OF BUSINESS)
J./, /1' /? ', / / SIDE YARD SETBACK I STREET ONT"Aur, HEAR YARD SETBACK
C4
7�
0
MIA
�7f 3
4CT
06
USE ZONE
LOT AREA
VACANT SITE
E3 YES NO
Y
/ Ll
TELEP ONE NUMBER
IIEIGTI—T
BUILDjNG AREA
VARIANCE NUMBER
I I
NAME
t
PLOTPLAN APPROVED
W
H
U
ADDRESS
STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
CITY
TELEPHONE NUMBER
COMP. PLAN ST. R/W ........... X`T. ............
0
Z
REMARKS
NAM
A,
ADDRESS
CHECKED BY
—CITY
—TALMoNE NUMBER
Q
METER SIZE SERVICE SIZE CLEARANCE
BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER
I I
ICHECKED
REMARKS
Lega escription of Property (Show B low or Attach Four Copies)
TYPE CONNECTION
VERIFIED BY
PERO. TEST
PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
[3 YES 13 NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
RESIDENTIAL
GAS
LINE
C] YES [3 NO
NEW
I
PLAN CHECKED By
rM
NON-RESIDENTIAL
LpJ
SIGN
RETAINING
REMARKS
0
DEMOLISH
J_J WALL
ElALTER
0
EXCAVATE
OR FILL
PENCE
( X Ft.)
REPAIR
El
PRE -MOVE
INSP.1
.......... ..........
swim
POOL
DWELLING
UNITS
NATURE OF WORK TO BE DONE
C_
PROPOSED USE
PLOT PLAN (Indicate Building Setb&CU, —abutting
03
t
N
I
I hereby acknowledge that I have read this application; that the in.
formation given In correct; and that I am the owner, or the du1Y author-
lzed 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; MoVFA)-IN BUILDINGS shall be com-
pleted In six months.)
11ONATURE (OWNER OR AGENT) DATE SIGNED
NOTE: Applicant Subject to Plan Check Fee
This Fern-dt covers work to be done on private property ONLY.
Any construction on the public domain (curba, sidewalUx, driveways,
marquees, etc.) will require separate permission.
Valuation
Fee
Receipt No.
Plan Check No ................ ...
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE:
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PER31IT
This application Is not a pernlit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
I ", /o - /6.- -6 �' I
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