690064.pdf. M
-1708,rED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant 011 NUMBER 690064
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
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NAME (OR NAME F BUSINESS)
BIDE YARD SETBACK STREET SETBACK _jj_E__AR YARD SETBACK
V C*
_AMLING ADDRESS
USE ZONE LOT AREA VAUXNT BITE
Ll 66""
CITY I TELEPHONE NUMBER [3 YES te'NO
HEIGHT BUILDING 'AREA.VARIANCE NUMBER P4
NAMID I I i
PZ� PPR ED
ADDRESS A el
STREF&R/W V
CITY E NUMBER EXISTING STREET R/W .......... FT. DEFICIENCY THIS PROPERTY
COISP. PLAN ST. R/W ............ FT. ...........
REMARKS
NAME
C4 _X55HESS Z
cHECKED BY
CITY TELEFRON19 14UMBER
Z
METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
STATE LICENSE NUMBER CITY LICENSE NUMBER
I REMARK13
Legal Desc on of Property (Show Below or Attach Four Copies)
A TYPE CONNECTION VERIFIED BY
Z
t PERO. TEST PERMIT NUMBER
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REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVE
45�
_Z� YES 0
RESIDENTIAL
F1
GAS
LINE
NEW
I
NON-RESIDENTIAL
SIGN
R1_ ADD
RETAINING
DEMOLISH
WALL
EXCAVATE
PENCE
ALTER
OR FILL
( . x Pt.)
REPAIR
PRE -MOVE
INSP.
........ ..........
swim
POOL
IUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
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.
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 WorkmeWo Compensation Insurance.
NOTE: Permit Limit One Year (Except DE310TATIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS hhall be oom.
pleted Irk six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private Property ONLY.
Any construction on the public domain (curbo, sideWAII&G, driveways,
marquees. etc.) will require separate permission.
E] YE13
..I
rian Check No....
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE;
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERAUT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
Pn 6-1107
Valuation
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.
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