690282.pdfPOSTED ON KR LL MAP NO.: PERMIT
NUMBER 690282
Applicant Fill r
inside Heavy Line E—JO13 ADDRESS ---------
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CITY TELEPHU14N VlJhdg�
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CITY TELEPH USER
NAME
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—CITY wt"� PRONE NUMBER
CITY 1AU1914SU NUMBER
.STATE ACENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
E17
GAR
E] NEW RESIDENTIAL LINE
SIGN
ADD RETAINING
ElDEMOLISH WALL
0 ALTER EXCAVATE PENCE
0 OR FILL .......... X .......... Ft.)
E] REPAIR PRE -MOVE
INSP.
NUMBER OF
DWELLING
UNITS
.:7- ;/__�
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JL_j 1:'11 An 'ARD SETBACK
YARD SETBACK ST ... LET SETBACK ILE
SITE
LOT AREA VACANT
E ZONE
YES NO
BUILIJINU
IEIGHT BUILDING
AlimA EDER
A10
�LOT L NAPP OVE
iTRE9T IIPN
EXISTING STREET R/W ............ FT.
DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ..... ...... FT-
............ FT.
Z
REMARKS
Z
-------------
CHECKED BY
METER SIZE SERVICE SIZE CLEARANCE
BY
I
ICHECKED
EM
REMARKS
t
TYPE CONNECTION
vEl"k"1Z BY
PERC. TEST
PERMIT NUMBER
V
REMARKS
FIRE ZONE
TYPE OF CONSTRUCT10N
Brit ET IMPROV
YES No
SPECIAL INSPEC.OR Q
T'�X� UIRED
OCCUP
NCY GROUP
YES
N97
97
-
A
IPLANCH
!K13
VP Plan Check No .....................
tan Check "a"* ..
BUILDING
PLUMBI NITG
BEAT & GAS LINE
f" 1.3
PENCE
SIGN
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-
ized agent of the Owner. I agree to comply with city and state laws regu-
lating construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Coda of the State of Washington
relating to Workmell"' Compensation Inlluran"-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ninety days' MOVED -IN BUILDINUS shall be com-
shall be completed in I
plated in six months.) t OR AGENT) DATE SIGNED
- "-)n— i - —) A T A` z 3
N07-E: y1pplicant Subject to Pla" Chech Fee
is property ONLY.
Two Permit covers work to be done (0enurpbra751dewmalts, driveways,
construction On the public domain separate permission.
Any marquees, etc.) will require
Valuation I Fee I Receipt No.
RETAINING WALL
SWIMMING POOL
606 /0. 4
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
(56&q
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application Is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
uty; and fees are paid, and receipt is ac-
wortit NOTED
knowledged in space provided.
INSPECTION
DIRECTOR'S NATUACE
DEPARTMENT
CITY OF
PDATV
L" 1,
EDMONDS
,.n ,
�3
I-R 6-1107
FILE
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