690458.pdfPOSTED ON KROLL MAP NO.: PERMIT
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BUILDIN6 DEPARTMINT Applicant Fin
NUMBER
I
PERMIT APPLICATION Inside Heavy Lines
JOB ADDRESS
NAME (OR NAME OF BUSINESS)
j PO QL 9 — E57 t:AJ RALc.�
1-t
SIDE YARD SETBACK STREET SETBACK
REAR YARD SET BACK
94
W
ILING ADDRESS
0
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USE ZONE LOT AREA
ANT SITE
-TIQ Mh
CITY 0140 NUMBER
/e,9
YES 0 NO
1-716-c16fq,
HEIGHT 13UILDING AREA
VARIANCE NUMBER
04
NAME
PLOT PLAN APPROVED
:4
ADDRESS
STREET R/W
TY
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
CITY TELEPHONE NUMBER
COUP. PLAN ST. R/W ............ FT.
............ FT.
REMARKS
NAME
AD
CHECKED BY
CITY I Mr.LRPHONE NUMBER
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
STATE LICENSE NUMBER -CITY LICENSE NUMBEkc
r
REMARKS
A�k1t7n-ofiRoperty (Show Below or Attach Four Copl;ea J
[3 YES [3 No
GAS
RESIDENTIAL F' LINE
[] YES E] NO
NEW
PLAN CHECKED BY
NON-RnSIDENTIAL SIGN
ADD RETAINING
REMARKS
WALL
DEMOLISH
k40Ck
ALTER EXCAVATE PENCE
OR FILL ( ......... x . ........ Ft.)
REPAIR PRE -MOVE swim
INSP. POOL
UBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Valuation
Fee
Receipt No.
C%&Q.M.Q IN
rian Check No ........ .... .......
BUILDING
PROPOSED USE
PLUMBING
2
PLOT PLAN (Indicate Building setbacE,-abutting streets)
HEAT & Awor=zm
ohc
PENCE
SIGN
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thlq 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 laws regu.
ATTENTION
APPLICATION APPROVAL
lating construction; and in doing the work authorixt4 thereby, no person
will be employed In violation of the Labor Code of the k:tate of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
ahall be completed In ninety days; MOVED -IN BUILDINGS nimll be com-
lmowledged in space provided.
pleted In six months.)
SIONATU;/O OR AGEN LWI bial"Nij
INSPECTION
DEPARTMENT
DIRECTOR' ONATU
CITY OF
EDAIONDS
Cliccl?. Fce
Di
NOTE: Applicaiit Subject to Plan
C�
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any ounstruction on the public domain (curbs, sidewalks, driverways,
FILE
Marquees, etc,) witl require separate permission,
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F�a me
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Final
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RECORD OF INSPECTIONS
Date Passed
Drainage
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Sewer
.,.Parking
�Andscaping f
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Fire Dept.
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