700184.pdf' BUILDING DEPARTMENT
PERMIT APPLICATION
Applicant F1U
Inside Heavy Lines
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LL MAP NO.: PERMIT
I NUMBER`
Vi�iv�__
BACK STREET SETBACK
REAR YARD SETBACK
LOT AREA
VACANT SITE
I YES No
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EUILDINO AREA
VARIANCE NUMBER
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ROVED
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USTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY f f
COMPo PLAN ST, R/W ............FT. ............PT. O i
_ � REMARKS f
NAME
U AUUMNIld
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CHECKED aY �
CITY TELEPHONE NUMBER
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METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
STATE LICENSE NUMBER I CITY LICENSE NUMBER I I I el J
REMARKS 44 2
Legal Description of Property (Show Below or Attach Four Copies)
TYPE CONNECTION VERIFIED BY '
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PERC. TEST I PERMIT NUMBER ayg,�y7 i
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
❑ YES ❑ NO
SPECIAL INSPECTOR REQUIRED (OCCUPANCY GROUP
OAS
RESIDENTIAL ❑ YES ❑ NO
NEW LINE PLAN CHECKED BY - (•
NON-RESIDENTIAL ❑ SIGN
ADD RETAI❑ DEMOLISH O WAS NINE REMARKS
ALTER ❑ EXCAVATE FEN .
FFILL (! .% _........Ft.)
OR .
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REPAIR O IN PPRE-MOVE ❑ POOL
NUMBER OF STORIES NUMBER OF - - - n
DWELLING
UNITS'
NATURE
�/OOFF WORK TO BE DrO�N�E' Valuation Fee Receipt No. `'' ' ' f„• �
lilTf/y �riV� �C /Ya.G .Plan Check No. ... ...._........... `: k
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BUILDING
PROPOSED USE — I
PLUMBING }
O PLOT PLAN (Indlcate Building setbacks, abutting streets) BEAT h GAS LINE I.
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f FENCE !�� �i o-� ,
SIGN
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tRETAINING WALL
ISWIMMING POOL
DEMOLITION_
PRE -MOVE INSPECTION q.
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EXCAVATION OR FILL
TOTAL AMOUNT DUE 1.
I hereby acknowledge that I have read this application; that the In. J
formation given Is correct; and that I am the owner, or the duly author- i
teed agent a Owner. I agree to comply with city and slate laws regu.
lating co tion; and in doing the work authorised thereby, no person ATTENTION APPLICATION APPROVAL
wlI) be em oyed In latf o bor Code of the State Of Washington THUS PERMIT This application is not a permit until
nlatln[ to or n's ComDensatlon rases. AUTHORIZES `
ONLY THE signed by the Building Official or his Dep-
E: Pe nit limit One Year ( eept! DEMOLITIONS which WORK jYOTED uty; and fees are paid, and receipt is ac- , I
11 b c pl ed In ninety days; MOVED- U s shall be com. knowledged in space provided. J
plated n s me a.)
SIGN (O R AGENT) TE SIGNED INSPECTION DIRE GNAT
DEPARTMENT
CITYOF V
EDMONDS DATE
NO Lo Applicant Srrbi ct to Plan Check Fee
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This Permit coven work to be done on private property ONLY. ,p•
Any construction on the public domain (curbs, sidewalks, drivoways, FILE G, 1
marquees, etc.) will malre separate permission. J
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