690033.pdfPOSTED ON KROLL MAP NO.: PERMIT T690033
NUMBER
DU LDING DEPARTMENT Applicant FM I
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
NAME (OR NAME OF BUSINESS)
SIDE YAR REAR YARD SETBACK
D SETBACK I STREET SETBACK
MAILINQ ADDRESS
U E ZO
LOT AREA
VACANT BITE
C 9TY TELEPHO NE NUMBER
I YES &*0
13
HEIGHT
BUILDING AREA
VARL&NCE NUMBER
I
NAME
EXISTING STREET R/W ............ Fr. DEFICIENCY THIS PROPERTY
CITY
TELEPHONE NUMBF-R
COMP. PLAN ST. R/W ............ FT. ............
REMARKS
NAM
ADDRESS
a
Z
CHECKED BY
CITY
TELEPHONE NUMBER
Z
STATE LICENSE NUMBER
CITY LICENSE NUMBER
METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
94
—RUM—ARKS
Legal Description of Property
(Show Below or Attach Four Copies)
2%
e
TYPE CONNECTION VERIFIED BY
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0
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PERC. TEST PERMIT NUMBER
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROV
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NEW
ID -ADD
ALTER
REPAIR
e-RESIDENTIAL
0
[![] LNON-RESIDENTIAL
M
GAS
LINE
SIGN
RETAINING
WALL
PENCE
( .... ..... x .......... Ft.)
swim
POOL
MDEMOLISH
EXCAVATE
M OR FILL
PRE -MOVE
El INSP.
DWELLING
UNITS
PROPOSED USE
PLOT PLAN (Indicate Building setbacks, abutting streete)
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1 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-
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 Workman's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ahaIl be completed in ninety days: MOVED -IN BUILDINGS shall be com-
pleted In six months.)
lIGN TUKE (OWNER OR,AG
DATE SIGNED
fl V// " , / -) 0 Z, cy
NOTE: Appli6nt Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (cwba, sidewalks, driveways,
marquess, ma.) will require separate pemission.
0 YES
1�AROW—W719A
Valuation
Plan Check No ...........
BUILDING
�_,o 0
PLUMBING
C>
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ArTENTION
THIS PERMIT
AUTHOMZE13
ONLY THE
WORH NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged In space provided.
I
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61
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cury, COPY
CITY OF EDMONDS
BLDG. DEPT.
IT
CONDITIONAL PERM
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WORK-
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ADDRESS-/
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