680544.pdf.... ........ . .. . ... .. . .... . .. - ---- ---
POSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant FM NUMBEM, 680544
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
NAME= OF B SINESS)
SIDE YARD SETBACK STREET SETBACK REAR YARD BET33ACK
MAILING ADDRE0
USE ZONE LOT AREA VACANT SITE
ON13 NUMBXR (3 YES
CITY E3 NO
I 1 0
&V4C54_ /&?(0 HEIGHT BUILDING AREA VARIANCID NUMBER
NAME
2 PLOT PLAN APPROVED
ADDRESS
STREET BIW
EXISTING STREET R/W ... ........ FT. DEFICIENCY THIS PROPERTY
CITY TELEPHONE NUM13ER
COMP. PLAN ST. R/W ............ FT. ........ ..
REMARKS
NAME
z
CHECKED BY
CITY TELEPHONE NUMBER
_-MATE LICENSE NUMBER CITY LICENSE NUMBER METER SIZE SERVICE SIZE CLEARANCE CHECKMD By
Legal Description of Property (Show Below or Attach Four COPI810 REMARKS
TYPE CONNECTION VERIFIED BY
PERC. TEST PERMIT NUMBER
REMARKS W
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
13 YES [3 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
GAS [3 YES NO
LINE
E] NEW El RESIDENTIAL El PLAN CHECKED BY
I El NON-RESIDENTIAL SIGN
r_1 A-D RETAINING REMARKS
ElDEMOLISH WALL /117 zzqz)
DALTER MCCLVATZ PENCE
El OR PILL ( ........ . X . ........ Ft.)
REPAIR PRE -MOVE SMM
INSP. POOL
MR or
DWZLLINQ
UNITS
NATURE OF WORK TO BE DONE —
Valuation Fee ecelpt No.
Plan Check No ..................
PROPOSED USE
BUILDING
PLOT PLA.N (Indicate Building setbacks, abutting streets) PLUMBING
ft HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that the In- iz=
formation given In correct: and that I ant the owner, or the duly author -
A
tzed agent of the owner. I agree to comply with city and state lawn rogu- T=NMON APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby. no person
will be employed in violation of the Labor Code of the State of WasbIngtOn THIS PERMIT This application is not a permit until
relating to Workmena CompennUtion Insurance. AUTHORIZES
ONLY THE signed by the Building Official or Ms Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS wvjhlch WORK NOTED uty; and fees are paid, and receipt is ac-
in
"I be completed in ninety days; MOVEDAIN BUILDINGS shall be com- Imowledged in space provided.
months.)
URE (0 D INSPECTION
OR AGENT) �t)E SIGNED DIRECTOR'S SIqNATU
aDEPARTMENT
s
CITY OF
DATE,, --
NOTE: Appfi"nt Subject to Plat; Check Fee EDMONDS
Thin Perndt coven work to be dona on private property ONLY. PH 6-1107
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.