700114.pdf......... .
MORE) ON KROLL MAP NO.: PEIUAIT -7
NUMBER 100114
t%U I LU I WU DEPAR I IVIEN Applicant Fill
PERMIT APPLICATION Inside Ileavy Lines —jiog ADDRESS
I NAME (Olt NAME OF BUSINEPS) cp.=I.�/7— 76
CITY /
llu=�.
NAME
W
ADDRESS
CITY
TELEPHONE N UMBER
NAME
C4
_TDDHESS
CITY
TELEPHONE NUMBER
-7,
STATE LICENSE NUMBER CITYLICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
-7
/07- AtFOCA4,5166ZFIV
Z
0A'
o
U/V
6,9 sp Ma Adt_
149 x Ale \AJ.
Z
RESIDENTIAL
GAS
LINE
NEW
NON-RESIDENTIAL
J
El
SIGN
ADD
RETAINING
M
DEMOLISH
ALTER
7-1
R
EXCAVATE
OR FILL
El
PENCE
( x Ft.)
REPAIR
7-1
I I
PRE -MOVE
INSP.
.......... ..........
swim
POOL
F-1
DWELLING
UNITS
t
N
I
I hereby acknowledge that I have read this application; that the In-
formation given in correct; and that I arn the owner, or the duly author-
ized 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 DEMOIATIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
f
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction an the public domain (curb*, sidewalks, driveways,
,,a,quees, ego.) will require separate permission.
SIDE YARD SETBACK STREET Sh;'EUAUI� REAR YARD SETBACK
i
.e cop
USE ZONE; LOTTW
VACANT SITE
YES N
Z
LEIG11T BUILDING AREA
VARIANCE UMB R
CW
pLOT PLAN APPROVED
6.
9TREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT.
REMARKS
CHECKED BY
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
REMARKS
TYPE CONNECTION
VERIFIED BY
0:
PERC. TEST
PERMIT NUMBER
REMARKS
FIRE ZO TYPE OF CqAI&MUCTlON I STREET IMPROVED
YES
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GpOUP
0 YES
PLAN CHECKED BY
REMARKS
A W64t 5U&)FC,77
V /)6Cj70/J t6 SEr IAJ ACCOX10
5
1j,fra 4r7eAqJ-tV
I
Valuation
roe
Receint ;7'.
rian Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
TIUM PERMIT
This application is not a perridt 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
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
,z,5 — (:Q 6- 7e)
Date Passed
Mrainage - ------ - 77-
Sewer
parking
Landscaping
Fire Dept.