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ERMIT APPLI
NAME OF BUSINESS)
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TELEPHONE
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AME
—TE—LEPHONE NUMBER
I TELEPHONE NUMBER
BER CITY LICENSE NU-Vdts�lt
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RESIDENTIAL
IN D
GAS
LINE
NEW
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El
NON-RESIDENTIAL E]
SIGN
ADD
F1DEMOLISH
D
RETAINING
WALL
DALTER
F
EXCAVATE
OR FILL F
FENCE
( x .......... Ft.)
..........
E] REPAIR
F-1
PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF
DWELLING
UNITS
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�JC_JJOLLMAP NO.: PERMIT -7
1 NUMBER 100108
013 ADDRESS
'T'
AR D 1ACK
3113111 --YARD SETBACK STREET SETBACK REAR YARD SETBACK
' SE
�Y
USE ZONE LUK AREA
IT
VACANT SITE
Rs— 2 1
10 Y S NO
1 1 YES No
tALUZIt
IIEIGHT I �BUILDING AREA VARIANCE N
P.
FEET —PLANAPPROVLD
f
STREET RIW
EXISTING STREET R/W ............ FT-
DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ Fr.
............ 7r.
0
REMARKS
Z
CHECKED BY
METER SIZE SERVICE SIZE CLEARANCE
BY
I
ICHECKED
:4
REMARKS
TYPE CONNECTION
VERIFIED BY
I
C9
PERC. TEST
PERMIT NUMBER
REMARKS
FIRE! Z02hL&_ TYPE OF COkWaUCTION
STREET IMPROVED
E]YES NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
YES Y-NO
PLAN CHECKED 33Y
REMARKS
I hereby acknowledge that I have read this application; that the In-
formation given to correct; and that I are the owmer, or the duly author-
ized agent of the owner. I agree to comply with city and state Iowa regu-
lating construction; and In doing the work authorized thereby, no Vernon
will be employed in violation of the Labor Code of the State of Washington
relating to Workmen's Compensation In3urance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shalt be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done an private property ONLY.
Any construction an the pubtle domain (curbs, sidewalks, driverways,
marquees. etc.) will require separate Permission-
Valuation
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Fee
No.
NTOTAL AMOUNT DUE 1 1 5—
ATTENTION APPLICATION APPROVAL
THIS PEnBUIT This application is not a permit until
AUTHORIZES signed by the Building official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
INSPECTION
DIRECT '18 SIGN
DEPARTMENT
CITY OF
EDMONDS DATY
3 - �;z :3 -70
PR 6-1107