690021.pdfPOSTED ON KROLL MAP NO.'. PERM
NUMBER
B ILDI G DEPARTMENT Applicant Fill
I- — 44!4021
PERMIT APPLICATION Inside Heavy Lines -TOB -ADDREss
NAME IOR NAXE1 OF BUSINESS) 1-7 3 1,J
SIDE YARD SETBACK STREET SETBACK REAR, YARD SETBACK
USE ZONE LOT AREA VACANT SITE
4! 40
wiaLLEPHONE NUMBER YES [3 NO
HEIGHT BUILDING AREA VARIJkNCE NUMBER 96
SAME
7�
PLOT PLAN APPROVED
...........
ADDRESS
tt STREET R/W
NO STREET R/W ........... FT, DEFICIENCY THIS PROPERTY
EXISTI
TELEPHONE NUMBER
COMP. PLAN ST. R/W ........... X-r. ............ FT.
__0
. ..... REMARKS
NAME
ADDRESS
CHECFJID BY
TELEPHONE NUMBER
METER SIZE SERVICE SIZE CLEARANCE CHECKED 13Y
STATE LICENSE NUM31ER C
8
LTY LICENSE NUMBER 94
REMARKS
Lega_l Description of Property (Show 'Below or Attach Four Copies)
TYPE CONNECTION VERIFIED 13Y
ZPERC. TEST PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 YES NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
GAS [3 YES 0
RESIDENT
L&L LINE PLAN CHECKED BY
NEW
DNON-RESMENTIAL 19IGN
I RETAINING REMARKS
0
ElDEMOLISH El WALL
E] ALTER EXCAVATE FENCE W1 M K 1 WC4— V06 L' OpL"I
OR FILL
F1 ._x . ........ Ft.
PRE -MOVE AW W4LkCS f1J 6-T
REPAIR -1 INSP. OL
F �rno
NUMB R OF
DWELLING kit U) &D
UNITS
NATTTRM OP WORIC TO HE DONE
Valuation Fee Receipt No.
rian Check No ............ .......
R
P OF OSED, USE
J
BUILDING
PLOT PLAN (Indicate Building setbarks, abutting street&)
PLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
N
RETAINING WALL
00
J 1A
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge 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.
ATTENTION
APPLICATION APPROVAL
lattne 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 permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
shoal be completed in ninety days; hlOVED-IN BUILDINGS shall be com-
knowledged in space provided.
pleted in six months.)
INSPECTION
DIRECTOR'S SIGNATURE
DEPARTMENT
/ 7
CITY OF
EDMONDS
DATE A
Pit 8-1101
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FILE
marquees, etc.) will require separate permission.