690089.pdf10
170-8—TED ON KROLL MAP NO.: VUUb')
BUILDING DEPARTMENT Applicant FIR
Inside Heavy Linea JOB ADDAE88
PERMIT APPLICATION
NA USINESS) f7q
(OR NAME OF B SIDEJYARD SE7 FLY- �SETBACK REAR YARD SETBACK
CHACK U171%
04 MAILING- ADDRESS VACANT SITE
LOT AREA
us YES !JtNO A
MISER
CITY TELEPHONE 14U
C' WIE-16ft-T 'ffUILDING AREA VARIANCE NUMBER 94
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NAME
PLOT PLAN APPROVED
W ADDRESS
STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
CITY UMBER
TELEPHONE V
COMP. PLAN ST. R/W ............ FT. ............ Pr. 0
REMARKS
NAM
CHECKED BY
Z.,
CITY TE"Pkiuriju NUMBER
DIETER SIZE SERVICE SIZE I CLEARANCE ICRECKED BY
Q STATE LICENSE NUMBER CITY LICENSE NUMBER Cd
I REMARKS
Legal Description Of Property (Show Below or Attach Four Copies)
fAc_ frso /L/
TYPE CONNECTION VERIFIED BY
Z
PERO. TEST PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
[] YES
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
RESIDENTIAL GAS 0 YES
ElNEW f. LINE PLAN CHECKED BY
1 1:1 NON-RESIDENTIAL SIGN I -
ADD RETAINING REMARKS L_�
1:1 DEMOLISH WALL
ALTER EXCAVATE PENCE
El OR FILL ( .......... x .......... Ft.)
REPAIR PRE -MOVE swim
INSP. POOL
NUMBER OF
DWELLING
U
NATURE OF WORK TO BE DONE
Valuation Fee Receipt No.
�O (kS LL- Plan Check No .....................
PROPO13ED USE
BUILDING
Q
satanic". abutting SEMCES) 6,,To
PLOT PLAN Kinaileate Isulpaing PLLTMBING
HEAT & GAS LINE
PENCE
t SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE 2
I hereby Oaknowledge that I have read this application; that the In-
formation given In correct; and that I arn the owner. or the duty author-
ized agent of the owner. I agree to comply with city and state laws regu-
laung 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: I%IOVED-IN BUILDINGS shall be com.
plated ttVilfr� months.)
SIGN HE (OWNER OR DATE SIGNED
NOTE: Applicant Subject to Plan Check Fee
'FhIs _PCMIt covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
ATMNTION APPLICATION APPROVAL
TIUs PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY TILE
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION DIRECTOR'S SIGNATURE
DEPARTMENT
CITY OF ATE
EDMONDS
PR 6-1107
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