700137.pdfPERMIT
POSTED ON KROLL MAP NO 100137
NUMBER
BUILDING DEPARTMENT
Applicant Fill
Inside Heavy Lines J013 ADDRESS
PERMIT APPLICATION
NAMLr Olt NAME F a 7&
SIDE YARD 8ETBACK STREET SETBACK HEAR YARD SETBACK
J MAILING ADDRESS
I
USE ZONE LOT AIRIEA VACANT 13ITI-1 74.
-CITY I TELEPHONE NUMBER 0 YES NO
c' \'R HEIGHT —_T _RTUTILDING AREA VARIANCE r9uMUNIS ;W
NAME
PLOT PLAN APPROVED
STREET R/W
j EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
CITY �1 TELEPHONE NUMBER
COMP. PLAN ST. R/W ............ p-r. ............ FT. 0
REMARKS
NAME
ADDRESS 1%
CRI.;uKED BY
TE
Ty LEPHONE NUM13ER
14
0 METER SIZE SERVICE E ICLEARANCE I CHECKED BY
STATE LICENSE NUMBER CITY LICENSE NUMBER C9
. . . . . . . . . . . W
E4
REMARKII
—0'a) �Z_
Legal Description of vroporty (Show Bclovf or Attach Four copies)
TYPE CONNECTION VERIFIED BY
PERC. TEST PERMIT NUMBER Cd
2 RESIDENTIAL El
GAS
LIND
DNEW
1
11 NON-RESIDENTIAL
D
SIGN
DADD
DDEMOLISH
El
RETAINING
WALE
DALTER
EXCAVATE
PENCE
D OR FILL
( ......... �x .......... Ft.)
REPAIR
PRE-UOVE
INSP.
D
swim
POOL
NUMBER OF
DWELLING
UNITS
OF WORK TO BE DONE
PROPOSED USE
4j�2
OT (Ild
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
[] YES 13 NO I
PLAN CHECKED BY
-I Plan Check No .....................
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
BUILDING
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 lawn rogu-
latlng 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 DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be oom.
pleted In six month;.),
3IG TORE (OWN2_,RO� AGENT) DATE SIGNED
C)
NOTE: AJ)Pficant Subject to Plan Check Fee
This remit coven work to Im done on private Property ONLIC.
Any construction on the public domain (curbs, sidewalks, drivoways,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMMNT
CITY OF
EDMONDS
PR 6-1107
0/cj; J
Valuation I Fee
z zf1
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or Ids Dep-
uty; and fees are paid, and receipt is ac-
Itnowledged in space provided.
DLRECTOR'S SIONAT
,YRE
17 L0
FILE
-10"S
co
�ECORD Oi- IMSPr-C'
Date passed
F ndation ---
ou
Plumbing (Partial.)
70 1VJ
(Rough)
Frame
Fur nace'�4f uel Lines--"
Final
RECORD 9F INSPECTIONS
Date Passed
Drainage
Sewer
Parldng
Landsca�ivg
Fire DePL