700264.pdfPOSTED 0 KROLL MAP NO.: PERMIT
100264
BUILDING DEPARTMENT Applicant F1 NUMBER
JOB ADDRESS
NAME (OR NAME OF BUSINESS) Inside Heavy XI/ C-O/;,�
PERMIT APPLICATION
CITY OF EDMONDS
MAILING ADDRESS
505 Bell Street
CITY TELEPHONE NUMBER
Edmonds
?76
NAME
ADDRESS
CITY
TELEF
I NAME
)NE NUMBER
C4 ADDRESS
CITY TELEPHONE NUMBER
STATE LICENSE NUMBER CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
WY2 of SY2 Lot 9 Block 4
T,akf% Rnl I j n Mer Tand Go S PI at
Subdivision No 1
Z
GAS
NEW RESIDENTIAL El LINE
:1 NON-RESIDENTIAL
D ADD El SIGN
RETAINING
EJ DEMOLISH WALL
DALTER EXCAVATE PENCE
RX OR FILL ( .......... x .......... Ft.)
REPAIR F_1 PRE -MOVE SWIM
INSP. El POOL
DWELLING
UNITS
I REAR YARD SETBACK i
1
0
il
USE ZONE
LOT AREA
VACANT SITE
I
YES NO
Z
JEIGHT
BUILDING AREA
VARIANCE NUMBER
PLOT PLAN APPROVED
STREET R/W
EXISTING STREET R/W ......... FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/WV1 .... FT.
a
RNAIARKS
Z
Z
C
METER SIZE
SERVICE SIZE CLEARANCE
CUELICED BY
REMARKS
TYPE CONNECTION
VERIFIED BY
PERC. TEST
PERMIT NUMBER
REMARKS
FIRE ZONE TYPO OF CONSTRUCTION STREET IMPROVED
YES r No
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
C] YES NO
PLAN CHECKED BY
REMARKS
I'lan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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 -
:zed agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the worlt authorized thereby, no person
will be emp!oyed 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 com-
pleted In six months.)
6 // 7-/ 70
NOTE: Applicant Subject to Plait Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbq, sidewalks, driveways,
marquees# etc.) will require separate permission,
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDBIONrS
PR 6-1107
Valuation
Fee
APPLICATION APPROVAL
No.
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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