690452.pdf:4
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BUILDING DEPARTMENT Applicant FIR
Itwille 11cavy Lines
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
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22906 76th Ave. W.
CITY
TELEPHONE NUMBER
Edmonds
77h 2964
_AAMEI
ADDRESS
CITY
TELEPHONE NUMBER
Ztt�2 D
A DDRESS
TELEPHONE NUMBER
'.LICENSE NUMBER CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
GAS
RESIDENTIAL LINE
NEW
-riFA4 P.
NON-RESIDENTIAL
SIGN
EJADD
RETAINING
TAII WALL
DEMOT
EXCAVATE PENCE
ALTER
F]
OR FILL F
REPAIR
-1
F
PRE -MOVE swim
INSP. F POOL
DWELLING
UNITS
erect temporax7 advertising signs.
PROPOSED USE
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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 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 DF51OLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
12/8/69
NOTE: Applicant Subject to Plats Check- Fee
This Permit covers %vork to be done On Private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marqueesp etc,) will require separate permission,
POSTED ON KROLL MAP NO.: PERMIT
NUMBER 690452
JOB ADDRESS
a act 0 &
SIDE YARD SETBACK STREET SETBACK REAR YARD UETBAUA
I LOT AREA VACAN_
USE ZONE 'T SITE
YES 13 NO
HEIGHT BUILDING AREA VARIANCE NUMBER
PLOT PLAN APPROVED
STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ Im
0
REMARKS
CHECKED Y
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
REMARKS
TYPE CONNECTION
VERIFIED BY
PERC. TEST
PERMIT NUMBER
V
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
[] YES NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
[] YES 13 NO
I
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PLAN CHECKED BY
Valuation
Plan Check No.
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN e
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Fee 'I Recefr-t No.
-9-0
hTOTAL AMOUNT DUE I I / 1 0-0 1 a-:2 J-�P.
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a perntit until
AUTHORIZES aigned by the Building Official or his Dep-
ONLY TI11E
WORK NOTED uty; and fees are paid, and receipt Is ac-
knowledged In space provided.
INSPECTION DIRECTOR'S ' 810
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
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