690255.pdfBUILDING5 UtrAKIMMI AppllcantFIR
PERMIT APPLICA1 Inside licavy Linem
j013 ADDRESS
NAME (OR NAM E DIP BUSINESS)
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SIDE YARD 81-YrDACK STREET SETBACK
ITE&A YARD SLIrDIV011
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MAILING ADDRE8%1?/'Lk%
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USE ZONE LAU A' ��A
VACA14T SITE
e#-17
Drily TELEPHONE NUM13ER
YES 13 NO
IrEIGHT BUILDIRG
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AREA VA RIANCE NUMBER
I
A�
NAME
PLOT PLAN APPROVED
A
ADDRESS
STREET R/W
EXISTING STREET R/W ............ FT.
RTY
DEFI�ZNCY THIS PROPERTY
CITY TELEPHONE NUMUNK
COMP. PLAN ST. R/W ............ PT.
............ FT.
REMARKH
NAME
42 d_/ e-If Ole 17
�a
ADDRESH.�
Z
CHECKED BY
CITY TELEPHONE N UM13ER
METER 81ZE SERVICE SIZE CLEARANCE CHECKED BY
STATE LICENSE NUMBER CITY LICENSE NUMBER
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REMARKS
Legal Description of Pr6perty (show Below or Attach Four copies)
TYPE CONNECTION
VERIFIED 13Y
r.
PLRC. TEST
PERMIT NUMBER
rA
id
— _V
REM.MKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVE
1-21
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1
2.J
[3 YES
—:--I:T
SPECIAL INSPECT:Oa��RIRED
OCCUPANCY GROUP
GAS
zr..,IDENTIAL El LINE
0
0 YES a 0
NEW
PLAN CHECKED BY
1 0 NON-RESIDENTIAL SIGN
1'4'1�
ADD - —] RETAINING
[_ DEMOLISH WALL
REMARKS
�ALTER EXCAVATE FENCE
El OR FILL El ( ........ . x .......... Ft.)
ElREPAIR PRE MOVE SWIM
1:1 INSP. El POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
e, 4--
4
01 --S—
PROPC
PLOT
Plan Check No .....................
BUILDING
PLUMBING
BEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
I EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given Is 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-
ATTENTION
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
TIUS PERMIT
I
relating to Workmen's Compensation Insurance.
AVTJIORIZES
NOTE: Permit Limit One Year (Excepr-11TIEMOLITIONS which
ONLY THE
WORli NOTED
shall be completed In ninety days; MOVED-IN/flUILDINGS shall be corn-
pleted In six months.)
TJ_G_N,%.TURE (OWNER Oft AGENT) DATE 81GNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
This rermit covers work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivew"s,
rnarqueeng etc,) Ivill require separate permission,
Valuation
_2
�� ?--., 0 o 1 .
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-
knowledged In space provided.
L -2
FILE
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