700143.pdf- - - - - - - - — -
pw",BUILUINU D E r A R 1 9 M I Applicant FIR
PERMIT APPLICATION Inside Heavy Lines
NAME (OR VAME] OF BUSINESS)
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PERMIT
NUMBER
-7
100143
RAEZ
TS RD SETBACK
a Qx ACK STUNEW UNI ACK Alt YA
7
-7 ;L,
USE ZONE LOT AREA VACANT bl'k=
(2 -S 1 1 [3 YES R1110
EXISTING . STREET R/W ............ FT. ' DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. ............ IT* 0
REMARKS 14
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TYPE CONNECTION
VERIFIED BY
2j )Z U
PERC. TEST
PERMIT NUMBER
(� IL' 0'/ /
PM.MARWR
M]
F-1 NEW
2- �U�
ALTER
REPAIR
FT-1-RESIDENTIAL
IE] NON-RESIDENTIAL
GAS
LINE
SIGN
RETAINING
WALL
FENCE
( .......... x .......... Ft.)
swim
POOL
-
RDEMOLISH
EXCAVATE
El OR FILL
PRE -MOVE
11 INSP.
El
IUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
VA�TTRM nF WnRIC Tn TIF nnNr.
TYPE OF CONSTRUCTION
0 YES 0 NO
ju Ain 4[4eglp Plan Check No .....................
BUILDING
PROPOSED USE PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
14 PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
ha t 'he In-
I hereby acknowledge that I have read this application; that the In-
d u I u 0
formation given is correct; and that I am the owner, or the duly author-
to I a e
L aw r gu-
Ized agent of the owner. I agree to comply with city and state laws regu-
c
ATTENTION
by. no person
lating construction; and in doing the work authorized thereby, no person
of Washington
will be employed In violation of the Labor Code of the State of Washington
Titis PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
jalch
NOTE: Permit Limit One Year (Except DEI%toLITIONS which
ONLY THE
WORK NOTED
a
shall be completed In ninety days; MOVED -IN BUILDINGS shall be oom-
pleted In six months.)
3IGNATURE, NER OR Aq�NTQ-y DATE SIGNE-D—
NE
INSPECTION
1 6
'05 76
7
DEPARTMENT
CITY OF
EDMONDS
NO�E: Applicant Subj'ect to Plan Check Fee
PR 6.1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
mmrqueesp etc.) will require separate permission.
0 YES [3 NO
Valuation I Fee
M11
No.
1 5 , I :rvel -,
APPLICATION APPROVAL
This application Is not a permit until
aigned by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
Imowledged in space provided.
FILE
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