700220.pdfPosTRD ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant Fin I NUMBER, 700220
PERMIT APPLICATION inside Heavy Lines joB ADDRESS -
NAME (OR NAME OF BUSINESS) I-e /� — 2(0-60 P/,
F9 -A A/ 1< E / FF SIDE YARD SETBACK STREET SETIA YAlW SETBACH
CK RE
MAILING ADDRESS
9 /0 - / 1?z 0,,Lf A/ USE ZONE LOT AREA VACANT SITE
_U�ry TELEPHONE NUMBER — / -� X YES [3 NO
5,0 /W 0 M O's 177K ZIS`6'�� HEIGHT BUILDING AREA VARIANCE NUMUNK—
NAME I
if 2 1�)O 27 .20 1177-5 027 P OVED
ADDRESS
2&E —
STRIZT R/W
2 �3 EXISTING STREET R/W lrb.FT. DEFICIENCY THIS PROPERTY
Z, t 9Y TELEPHONE NUMBER MP. PLAN ST. R/W FT.
JCPM 94/P.5 RE`.0A ...... q..FT. 0
NAME Driveway slopes not to exceed those—
C4 indicated on Standard Drawing #103.
ADDRESS
CHECKED lix
CITY TELEPHONE 14UMBER
Z
0 METER SIZE SERVICE SIZE CLEARANCE CHECKER BY
STATE LICENSE NUMBER CITY LICENSE NUMBER
1 C�36 � - 7 (F
Legal Description of Property (Show Below or Attach Four Copies)
LOT 9
TYPE CONNECTION VERIFIED BY
/V PERO. TEST XMB
Q
REMARKS M
FIRE Zo!�4 I TYPE OF CONS UCTION REET IMPROVED
4YES [3 NO
SPECIAL INSPECTOR REQUIRED OCCUPA:YROUP,
GAS 13 YES ANO
NEW RESIDENTIAL L&J LINE PLAN CHECKED BY
NON-RESIDENTIAL 1:1 SION
17 ADD RETAINING REMARKS
ElDEMOLISH 1:1 WALL
ElALTER EXCAVATE PENCE
1:1 OR FILL 0 ( ......... x .......... Ft.)
REPAIR PRE -MOVE swim
El INSP. 1:1 POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS /1
NATURE OF 4.
WORK TO BE DONE Valuation Fee —RecelPt No.
Plan Check No .....................
0 PROPOSED USE BUILDING &0 go
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL Iml
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given Is correct; and that I tun the owner, or the duly author.
lzed 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 ATTENTION APPLICATION APPROVAL
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT This application Is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
NOTE: Permit Limit One Year (Except DE51OLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com. knowledged in space provided.
pleted In six months.)
SIGNATU WNER OR AGENT) DATE SIGNED INSPECTION DIRECTOR'S SIGNATURE
7 0 DEPARTMENT
CITY OF
DATP-
r EDMONDS
NOTE: Applicant Subject to Plan Check Fee
Pit 0-1107
This Permit coven work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways, FILE
marquees, etc.) will require separate permission.
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