690456.pdfPOSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT
NUMBER
Applicant Fill
Inside Heavy Lines j0H ADDRESS
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS) S�, 45.
SIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK
4.kILING ADDRESS
VACANT SITE
USE ZONE LOT AREA
TELEPHONE NUMBka?.
171Y r 0
YEB �(NO
W dr-u- 77 If D 20 IIEIO1IT BUILDING AREA VARIANCE NUMBER 04
X N!L" PLOT PLAN APPROVED
en
ADDRESS
STREET R/W
R/W ............ FT. DEFICIENCY THIS PROPERTY
EXISTING STREET
CIF TELEPHONE NUMBER 'T.
COMP. PLAN ST. R/W ............ F ............ FT.
C/ REMARKS
NA.MSI
_7
ADDRESS F
"7" Z
TELEPHONE NUMBER CHECKED BY
CITY
4LLLL STATE LICENSE NUMBER CITY LICENSE NUMBER METER SIZE SERVICE SIZE CLEARANCE CHECKED BY Cd
REMARKS
Legal Description Of Property (Show Below or Attach Four Copies)
1 -w "7 TYPE CONNECTION VERIFIED BY
pa &1. 01 1 L
Z U
PERO. TEST PERMIT NUMBER
77n
ofa 2—
Xv T
REMARKS
FIRE ZONE TYPE OF CONST�LLICMION STREET IMPROVED
�J El YES [3 NO
SPECIAL INSPECTOR REQUrRED OCCUPANCY GROUP
0 YES YNO
GAS
NEW N RESIDENTIAL LINE PLAN CHECKELF BY
1 11 NON-nESIDENTIAL SIGN
ADD RETAINING REMARKS
1:1 DEMOLISH WALL
ALTER EXCAVATE PENCE
OR FILL ( ........ X .......... Ft.)
F1 El
REPAIR PRE -MOVE swim
F-1 INSP. POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NAT
OF WORK TO BEQ9
'AFL_ Valuation Fee Receipt No.
Plan Check No .... .... ...........
BUILDING ?06�
PROPOSED USE
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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-
ized agent of the owner. I agree to comply with city and state lawn regu-
lating construction; and In doing the work authorized thereby, no person ATTENTION APPLICATION APPROVAL
will be employed In violation of the Labor Code of the State of Wanhington TIJIS PERMIT Tills application Is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by tile Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which ONLY THE uty; and fees are paid, and receipt Is ac-
shall be completed In ninety days; MOVEDAN BUILDINGS shall be corn- WORK NOTED
knowledged In space provided.
pletedfin nix months.)
�11111111111'u RE ER R — EN SIGNED INSPECTION DIRECT6P_Jff_8I k
CITY OF
DEPARTMENT
f7b
/JA M
EDMONDS DATE/ %J
AWE: APp'ficant Subject to Plats Check Fee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Amy construction on the public domain (curbs, sidewalks, driveways, FILE
marquees, etc.) will require neparate permlsolon.
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