690322.pdfQ
i. �i ✓il` q p}tI rill
., � N1 .il efYM A II�IMMIe dIbY WIY iW
{ r i
' t
POSTED ON KROLL MAP NO.: I PERMIT L 9�32�i .�
gi,nyy BUILDING DEPARTMENT ApplicantFm NUMBER
Q/ LL
' PERMIT APPLICATION Inside Ilea Lines
JU r �rvsy'�1 Yl., 8 ADDRESS .. 1
to
°`r5„*iXrt t j :1 R NAME OF BUSINESS)
SIDE YARD SETBACK I STREET SETBACK I lk
REAR YARD SETBACK
�i rw ii JUILING ADDRESS O
1 ." / / USE ZONE LOT AREA VACANT BITE A
of TELEPHONE NUMBER I I [] YES [,l NO
HEIGHT
I BUILDING AREA I VARIANCE NUMBER
'la NAME
PLOT PLAN APPROVED �.
i
,ADDRE88
t
STREET R/W -
f TELEPHONE NUMBER EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY t ;
t
rJ, COMP. PLAN ST, nM ............FT. ............FT. 0
3:
REMARKS ..
1 NAMD tGhdi
O
ADDRESS x �
CHECKED BY
` TELEPHONE NUMBER
CITY ;
1S`Fin �xh" I KED BY t
,. STATE LICENSE NUMBER CITY LICENSE NUMBER METER SIZE SERVICE SIZE CLEARANCE CHECI I I It
a
v ar}d r. •�
REMARKS
•',''',' Legal Description of Property (Show Below or Attach Four Copies) '
sr r ,
TYPE CONNECTION (VERIFIED BY ,.
t1
`f F PERC, TEST I PERMIT NUMBER a
Y ,
i .ier' al ) 70 REMARKS m
ell
n4
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
G` •i
`'i aJ�l ' ❑ YES NO
1,r + SPECIAL INSPECTOR REQUIRED (OCCUPANCY GROUP
v ' O 6A8 ❑ YES ❑ NO
v ❑ RESIDENTIAL LINEllllllllllPllll
s NEW PLAN CHECKED BY
NON-RESIDENTIAL ❑ SIGN
ElADD RETAINING REMARKS ,1
DEMOLISH WALL
ALTEREXCAVATE FENCE
OFILL ........ ..x.......... Ft')
REPAIR ❑ PRE - swim
INSPM0� POOL
r
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS '
NATURE OF WORK TO B DONE Valuation Fee _ Receipt No.
Z. Plan Check No, .... ..............
1.
yBUILDING
PROPOSED USE .
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT & GAS LINE
,Y FENCE
SIGN
"s''
1 )
RETAINING WALL �
N �
ISWIMMING POOL j
DEMOLITION
i
i
PRE -MOVE INSPECTION
EXCAVATION OR FILL �.
i
- i
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 raga- ATTENTION APPLICATION APPROVAL _
Jailing construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington TIES PERMIT This application is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES eigr-ed by the Building Official or his Dep-
ONLY TILE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED utyi and fees are paid, and receipt is ac-
shall be complete ty days; MOVED -IN BUILDINGS shall be core- knowledged in space provided. j
pleted 1a six s.)
S1 AT OWNE OR AGENT) DAT IGN D INSPECTION DIRECTOR'S NA
tJ DEPARTMENT ' I
x G CITY OF DAB T f
EDMONDS "' '
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction at the public domain (curbs, sldewallu, drlvewsyst FU .
marquees, etc.) wW require separate permisslm.