690423.pdfPOSTED ON XROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant Flu NUMBER 6'90423
PERMIT APPLICATION Inside Heavy Lines JOB ADDRE88
NAME (OR NAME OF BUSINESS) '* // / 0 (P 0
SIDE YARD SETBACK STREET SETBACK REAR YARD SET K
MAILING ADD 88 go 0
/ a I *OF.
P-700z USE ZONE LOT AREA VACANT SITE�
TELEPHONE NUMBER
CITY ;�6zv /_ 1 [3 YES
11MIGHT, IJUILDING AREA VARIANCE NUMBER
NAME
PLOT PLA
0�
fN�P ED
ADDRESS
'IT
U ==TREET R/W ............ FT. DEFICIENCY THIS PROPERTY
CITY TELEPHONE NUMBER
COMP. PLAN ST. R/W ............ FT. ........... IV.
RERXRKS
ADDRESS or
Z
'S CHECKED BY
CITY TELEPHONE NUMBER
Ma
7- MI1TEI1 SIZE SERVICE SIZE C ARANOE CRECKED BY
yr
STATE LICENSIG NUB113NIC CITY LICENSE NUMBER
REMARKS
Legal Description of PropUty (Show Below or Attach our Copies) .
TYPE CONNECTION VERIFIED BY
PERO. TEST PERMIT NUMBER
4
J2 ell
ItEMARKS
FIRE ZONFL.- TYPE OF CONSTRUCTION STREET IMPROVED
:&� I ki 1 0 YES El NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
[3 YES NO
GAS
J&.91DENTIAL
Er.EW LINE PLAN CHECIL% By
��rx()N-RMSIDENTIkL El SIGN A/ "I
[2�JADD
RETAINING RE
ElDEMOLISH WALL
PENCE
ALTER EXCAVATE 494ccs f;
ILL El ( .......... X .......... Ft.)
OR r "I
REPAIR PRE -MOVE SWIM
W
F1 INSP. POOL
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE Valuation Fee fielcipt NO.
Plan Check No ... . ...............
20;
BUILDING
PROPOSED U13M
PLUMBING
PENCE
setbacks, abutting streets)
PLOT PLAN (Indicate HEAT & GAS LINE
IGN
N
SZ4 RETAINING WALL
J"
'4 SWIMMING POOL
DEMOLITION
44� _1 'k. PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE 0-V
I hereby acknowledge that I hive read this alllc�atlowthat 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. NTION APPLICATION APPROVAL
latIng construction; and In doing the work authorized thereby, no person ATTE
will be employed in violation Of the Labor Code of the State of Washington THIS PER311T This application Is not a permit until
relating to Workmen -a Compensation Insurance. AUTHORIZES
ONLY THE signed by the Building Official or his Dep-
NOTE: Permit Limit one Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
shall be completed In ninety days: MOVED -IN BUILDINGS shall be com. knowledged In space provided.
ploted In six months.)
SIGNATURE (OW AG DATE SIGNED INSPECTION
NER 0 DIRECTORIS SIGNATURE
DEPARTMENT 7
CITY OF
EDMONDS
V
NOTE: Applicant Subject to Plan Check, Fee rn 6.1107
This Fermit covers wark to be done oil private property ONLY.
Any construction on the public domain (curbs. sidewalks, driveways, FILE
marquees, etc.) will require separate PermiNNICe.