700235.pdf_V
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POSTED ON KROLL MAP NO.: PERMIT
I NUMBER
7002355
BUILDING DEPARTMENT
Applicant Fill
PERMIT APPLICATION
inside lleavy Lines
I
JOB ADDRESS
NAME (OR NAME OF BUSINESS)
0
SIDE YARD z3&TBACK
STREET SITTIJAUM
HEAR YARD SETBACK
Rich&d Wa
?41
Sgner
LING RE
74
2-if A f_
USE ZON E AREA VACANT ITE
7 e
RA4L
YES 0 NO
I -
J� f
CI Y
_1UN"UP—HONE""NUMBER
"EIGHT
BUILDING AREA
N NU ER
VARIA CID MB
96
Wlpw 71 IA� 6,�,O_r4
t7_7 79
I 125th St Em 4-1960
Z
irty (Show Below or Attach Four Copies)
RESIDENTIAL
GAS
LINE
FENEW
NON-RESIDENTIAL
SIGN
El ADD
RETAINING
DEMOT,TAff
WALL
ElALTER
D
EXCAVATE
OR FILL
FENCE
( x Ft.)
.......... ..........
REPAIR
Q
PRE -MOVE
INSP.
SWIM
POOL
4UMBER OF
STORIES
NUMBER OF
DWELLING
UNITS
UATURE F®r
WORK TO 13E DONE
Rough in and
install plumbing
,� I —
- 0. "A'. f��.r
'ROVED
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
............ I
COMP. PLAN ST. R/W ........... XT- �T.
REMARKS
0
CHECKED BY
METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
REMARKS
TYPE CONNECTION VERIFIED BY
PERO. TEST PERMIT NUMBER 0:
REMARKS
0 YES A NO
PLAN CHECKED BY
REMARKS
-ikikA�. rlonils-'S-
Plan Check No ........ . ...........
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
I EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the
in-
formation given In correct; and that I ara the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
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
THIS PERIVIXT
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS whicl
h
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
IIG7NAT RL--MWNNlC Olt Auz'N 1) 1
DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
Pit 6-1101
Title permit covers worU to be done on private Property ONLY -
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Fee
IMPROVED
C] NO
M.
No.
1 ;5-4 , I
APPLICATION APPROVAL
This application is not a permit until
oigned by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged In space provided.
111-R—ECTOR'S qIGNATURE_,
-/ o
FILE
I
Drainage
Sewer
Parking
Landsca ping
Fire Dept.