690400.pdfPOSTED 76—N KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant Fill NUMBER 690400
Inside Ileavy Lines juB ADDRESS
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS),
Cf. p v /Y SIDE YARD 13LT13ACIC STREET SETBACK RFAK y1ulD SETBACK
_VA_1MNGJLDDREBS a
USE ZONE LOT AREA VACANT ULKX5
CITY ELEPRON10 NUMBER YES NO
4 cE NUMBER
-776 HEIGHT injiLDING AREA VARIAN Ck
NAME I I
PLOT PLAN APPROVED
W ADDRESS
hTBEET
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
CITY TELEPHONE NUMBER COMP. PLAN ST. R/W ............ FT. ... ........ TT.
I REMARKS
NAME
ADDRE13B
Z
6` 7
CHECKED BY
CITY TELEPHONE NUM13ER
0 METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
STATE LICENS13 NUMBER CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
Z7— TYPE CONNECTION VERIFIED BY
PERC. TEST PERMIT NUMBER
W REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
[]YES I NO
Xr
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
GAS 0 YES [J NO
NEW RESIDENTIAL LINE PLAN CHECKED BY
NON-RESIDENTLALL D SIGN
RETAINING REMARKS
DEMOLISH WALL
ALTER EXCAVATE PENCE
F] OR FILL ......... Ft.) 47
REPAIR PRE -MOVE SWIM
El INSP. POOL
DWELLING
UNITS
NATURE OF W RK TO BE DONE
I hereby acknowledge that I have read this application; that the In-
formation given In correct; and that I am the owner, or the du]Y 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 Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
plated In air
,#onUV;j' _...
51ONA (O.WYER V,AGENT) DATE SIGNED
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sldcwadka� drivewayst
m"Quees, etc.) will require separate permission,
Valuation I Fee
rian Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIM NG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
��o
TOTAL AMOUNT DUE
I
I C;)/ 'IV,
I
A=NTION
APPLICATION APPROVAL
THIS PERMIT
This application Is not a permit Until
AUTHORIZES
eigned by Me Building Off Iclal. or his Dep-
ONLY THE
uty; and fees are paid, and receipt Is ac-
WORK NOTED
Imowledged in space provided.
INSPECTION
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DIRECTj� !�FURE
DEPARTMENT
�R'Sl
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CITY OF
DATE I XJ
EDMONDS
/�o — COP
PR 6-1107
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Drainage
Sewer
Parking
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Fire Dept&
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:4. RECORD OF INSPECTIONS
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Date Passed
4 0 1 1 '1' r— L '.4 'r Foundation
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4 1 1 d 1. 1 �14 i I I L I (Rough)
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