690326.pdfPosTFD ON KH MAP NO.: 6'90326
BUILDING DIIARIMINI Applicant Fill.
PERMIT APPLICATION- Inside 11cavy Lines 22 11 _7
NAME (OR NAM13 OF BUSINESS) 924 - 761h Avenue West - ETBACK
TBACK REAR, YARD 8
SIDE YARD SET'3AM 1 UTnl"FT BE
chie-
MAIIA ADDRESS of Z
�&A 51 VAC 71
USE ZOO LOT ANT SIT13 4
--cul—TY 11719 N. T LEPHGNE NUMBER 10 1 [3 YES (3 NO .1
1EIGHT BUILDING AREA VARIANCE NUAIZZLS 96
eattlell _nn R11 ;)---7
I NAM
ILOT PLAN APPROVED
J
STREET R/W�
REET RIW ............ FT. DEFICIENCY THIS PROPERTY
TELEPHONE NUMBER EXISTING ST
CITY COMP. PLAN ST. R/W ............ . M- ............ Pr.
-r.2 3_ni*j4
REMARKS
Qttl
N
Owner
ADDRESS
CHE Y
CITY TELEPHO NUMBER
QLEARANCE CHECKED BY
METER SIZE SERVICE 131ZE
STATE LICENSE NUMBER CITY LICENSE NUMBER
REMARKS -
Legal Description of Property (Show Below or Attach Four copies)
TYPE CONNECTION VERIFIED BY
r2ct 'Rc TEST PERMIT NUM-3ER
ni! ske3:knrils lake McAleer 5 QCr* PE
as per plat recorded in vol. 6 of plat
REMARKS
21, rgcords of S ohomish County
P
Z ROVED
FIRE TYPE OF CO CTION STREET IMP
YES E] NO
�U—ffdm- OCCUPANCY GROUP
GAS YES NO
RESIDENTIAL LINE PLAN CHECKED BY
NEW NON-RESIDENTIAL SIGN
ADD RETAINING REMARKS
DEMOLISH El WALL
ALTER EXCAVATE PENCE
F-1 OR FILL El ( .......... x .......... It.) Rvok
PRE -MOVE swim k—:-V.H IT 1010
REPAIR INSP. POOL
DWELLING
UNITS
Recreation Room
t
N
I
I hereby acknowledge that I have read tl,.Is application; that the In-
formation given to 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 rogu-
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
relating to Workmen'd Compensation Insurance.
NOTE: Permit Limit Oiie Yecir (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
4,
7
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done an private property ONLY.
Any construction on Ule public domain (curbs, sidewalksp driveways,
marquees. etc.) will require separate permission.
valuation
Plan Check No
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Fee
No.
TOTAL AMOUNT DUE
ATTENTION APPLICATION APPROVAL
THIS pritslIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
WO1aH NOTED uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
INSPECTION
DIRECTOR'S SIONA7URE
DEPARTMENT
CITY OF --B-A—TE
EDMONDS
PR 6-1107
Parking,.,.
Landscaping
Fir6 Dept