690150.pdfPOSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT AppUcant Fin NUMBER 690150
Inside Heavy Lines JOB ADDRESS
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
-,AN and/or ProIline SIDE YARD BEITBACK STREErr SETBACK xtz��. ARD SETBACK
Y B
P
0 ADD�T
Es
SIT
USE ZONE W AkLNA VACANT SITE
19524-80th Ave. W. 4,r -3 q
y
0 -CITY TELEPHONE NUMBER je T'r-) [3 YES X—.14, 0 —
T411711CWTDC), PR 8 19130 HEIGHT' UILDING ARE& VARIA141jig riUM" 96
NAME
PLOT PL
ADDRE88
STREET RIW
CITY TELEPHONE NUMBER EXISTING STREET R/W ....... .... FT- DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. ......... .. FT.
REMARKS
NAME
SELF
0
M Z
ADDRESS CHECKED BY
CITY TELEPHONE NUMBER
METER SIZE SERVICE SIZE CLEARANCE CHECKED By
STATE LICENSE RUMBER ICITY LICENSE NUMBER REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
Soli-th 325 ft- of 'the East 175 ft. of TYPE CONNECTION VERIFIED BY
Z
0 1
East 1/2 of SE 1/4 o.' 51,7 1/4 of SE 1/4 PERC. TEST PERMIT NUMBER
of 9oct. IR, Tovalshin 27 N, RinF.,e 4 E,
REMARKS
Less E 201 �r Less S 301 thof -
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
I- 1 0 YES [3 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
MV GAS 0 YES [:I NO
F� NEW I A[ RESIDENTIAL D LINE PLAN CHECKED BY
ElNON-RESIDENTLALLI D SIGN
rXfl ... U. RETAINING REMARKS
DDEMOLISH El WALL
ALTER EXCAVATE PENCE
El OR FILL El I .......... X .......... Ft.)
REPAIR PRE -MOVE swim
El INSP. El POOL
NUMBER OF STORIES Num"M" OF
DWELLING
UNITS
NATURE OF WO]
PORCH
Fee RecclDt No.
Mn Check No ............ . .......
PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
TOR IVG WAY
DECK
FENCE
Am) I L
9w,"_ 754
AF??D)( I
E;
t
N
��l
SIGN
RETAINING WALL
14J
SWIMMING POOL
DEMOLITION
JP
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
ATTENTION
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 lawn 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
THIS PER511T
rotating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
AUTIIOIUZES
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED-111 BUILDINGS shall be eom-
pleted In six months.)
INSPECTION
DEPARTMENT
3IGNATURE (OW R OR AG7WT/r, DATE BIG D
4_70407
CITY OF
EDMONDS
NOTE: ApPlicant Subject to Plan Check- Fee PR 6-1107
This Permit covers work to be done on private Property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways.
marquees, etc.) will require separate permission.
I S'. 0 C) I N 1:5-a
APPLICATION APPROVAL
This application is not a pern-at until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
P
J
4 6 t.lp:
2ili
I
RECORD OF INSPECTIONS
Date,passed,
Drainage
Sewer
Parking
Lan&caping
Fire Dept.