690194.pdfell
POSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT I NUMBER 690194
App'licant MR
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
NAME (OR NAME OF BUSINESS) r7f -�Z- o'Z o 9 X
IV) e— -A -'s SIDE Y D 8 BACK STREET SETBACK REAR YARD
C4 M a"s 2 6 r"
M I* I LING ADDRESS fA 77? Z*�j
vACANT SITE
USE LOT AREA
q.3 4j �,2
TELEP21UNM NUMBER 0 YES 0
CITY 7) 9 1 1
e. J ma,.j la- 778- HEIGHT BUILDINGAREA ?ut R
NAME I I
PLOT PLAN APPROVED
ADDRESS
STREET R/W
EXISTING STREET R/W DEFICIENCY THIS PROPERTY
CITY TELEPHONE NUMBER COMP. PLAN ST. R/W ........... XT. 0
REMARKS
NAM
ADDRESS UnEcicyn BY
CITY ELEPHUNIU NUMBER
14
STATE LICENSE NUMBER CITY LICENSE NUMBER METER SIZE I SERVICE] SIZE CLEARANCE CRECICED 33Y
REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
W�L41' 10-7 f'--7- of 73, S' -1 17 [4,T af 7 'Ad 4 15 TYPE CONNECTION VERIFIED BY
yq flf -1'4 ar -secV.,J 1; iv,le. PERC. TEST PERMIT NUMBER
non 14 rZ, W. S 4 7L AJ 13it'Ph JA V f-! C r Q i-rASE REMARKS
07 Tze" lksett . 4:'. &-r'joc J4 n FIRE Zgnzi-- TYPE OF CON UCTIO STREET IMPROVED
b'M Sreir t -Tu�- 1� [] YES El NO
1 7. 1
SPECIAL INSPECTOR REQUIRED OCCUPAN
GAS 0 YES �<NO _rOUP
ru RESIDENTIAL
E] NEW 1,161 PLAN CHECKED IIWJ
ElNON-RESIDENTIAL SIGN
RETAINING REMARKS
DEMOLISH El WALL
ALTER EXCAVATE PENCE pume.'� -.5 oejecr zz
F� OR FILL El ( .... .... �x . ........ Ft.) ON -
REPAIR PRE -MOVE SWIM
INSP. NUMBER OF Ej POOL
DWELLING
--ri.1 el UNITS 0 /V C
0
P %
Plan Check No ..................
PROPOSED Un
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
03 PA'
2 6-3 -S I
HEAT & GAS LINE
PENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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 allttDr-
ized agent of the owner. I agree to comply with city and state lawn regu-
ATTENTION
lating construction; and In doing the work authorized thereby. no person
will be employed in violation of the Labor Code of the St&te Of Washington
THIS PERMIT
relating to Workmen-0 Compensation Insurance.
AUTHORIZES
NOTE: Permit Umit One Year (Except DE51OLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVEnk-IN BUILDINGS shall be com-
plated In six months.)
— SIGNED
RE (0 4ER NT) DATE
INSPECTION
DEPARTMENT
2ORk
CITY OF
V
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This rermit covers work to be done an private property ONLY.
Any construction an the public domain (curbso sidewalkag drivewayst
baa,rqueeg, etc.) Will require separate permission.
0 '0-�-
Fee
t
No.
R V M00 10761 a E, I
APPLICATION APPROVAL
This application is not a pernlit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
lmowledged in space provided.
I
N