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pOSTI3D ON KROLL MAP NO.: PERMIT
CDAD-r cuT I NUMBER 690092
PERMIT APPLICATION
Applicant 11
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TELEPHONE
NUMBER
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PHONE NUMBER
STATE LICENSE NUMBER
CITY
LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
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RESIDENTIAL
GAS
LINE:
NEW
NON-RESIDENTIA
SIGN
ElDEMOLISH
RETAINING
WALL
ALTER
EXCAVATE
OR FILL
PENCE
( .......... x .......... Ft.)
REPAIR
PRE -MOVE
F-1 INSP.
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POOL
DWELLING
UNITS
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I hereby acknowledge that I have read thin 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-
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; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the pubUe domain (curbs, sidewalks, driveways,
marquees, ate.) will require separate permission.
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BUILDING VARJANCE NUMBER
PLOT PYN OVED
STREET W
EXISTIN STREET R/W .�7= ... FT- DEFI="! PERTY
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COMP. PLAN ST. R/W = ... FT.
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REMARKS
Driveway slopes not to exceed those
indicated on Standard Drawing #103*
CHECKED BY
BiETER SIZE SERVICE SIZE CLEARANCE CHECKED BY
94
REMARKS
TYPE CONNECTION
VERIMED BY
2-
PERO. TEST
PERM�'TJNUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES 0
E;OR
07� D
OCCUPANCY GROUP
No
YES NO
PLAN CHECKED BY
No.
REMARIr
Valuation
Fee
Receipt
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
FEE
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
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AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION DIREG1�G"W__S!7ff1_G_NAL
IV
DEPARTMENT
CITY OF
DA%E'
EDMONDS
PR 6-1107