700316.pdfBUILDING DEPARTMENT Applicant F1U
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
7-OeV
MAILING ADDEW313
Q36-l? _?62�lr GJ4
CITY TSLNP11UVE NUMBER
C- 4"Olvo-S . I r2je 6 - 7 6 7-46
NAME
ADDRESS
CITY
TELEPHONE NUMBER
NAME
07.13.
ADDRESS
C4
0
CITY
TELEPHUNN NUMBER
Z
STATE LICENSE NUMBER
CITY LICENSE NUMBER
Legal Descri—ptionof Property (Show Below or Attach Four Copies)
S7 919 So uM vS- IYOR77Y'
Z
y
.n
a
1 A C r_S
0 NEW
DADD
W MALTER
REPAII
U
/IV LIOL. 0 ,- 1��447_-7
RESIDENTIAL
GAS C:0'1/Vi
LINE
NON-RESIDENTIAL
SIGN
F1DEMOLISH
El
RETAINING
WALL
EXCAVATE
on FILL
FENCE
( .......... x .......... Ft.)
EPRE
-MOVE
] INSP.
S WIM.
POOL
DWELLING
UNITS
t
N
I
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-
tzed agent of tho owner. I agree to comply with city and state laws regu-
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
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS wh!ch
nhall be completed In ninety days; MOVED -IN BUILDINGS shall be win -
plated In mix months.)
e.
�, -16 - -2 o
NOTE: Applicant Subject to Plats Check Fee
This Permit coven work it) be done on private property ONLY.
Any conatrUctioll on ilia public domain (curbs, nidewaflis, drivewaysp
muequees, etc.) will require separate permission.
PERMIT
NUMBER
Z 457 / 7
3IDE YARD SET ;K 13TI NET SETBACK REAR YARD SETBACK
LOT AREA VACANT SITE
USE ZONZ—
Z
4 13 YES (?_4 0
HEIGHT Bulljjivu AREA VARIANCE NUMBER
PLOT PE_A_N APPROVED
STREET R/W
EXISTING STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ...... _.FT. ............ 7T. 0
REMARKS
Z
CHECKED BY
METER SIZE SERVICE SIZE CLEARANCE ICHECKED BY
I
REMARKS
TYPE CONNECTION VERIFIED BY
PERC. TEST PERMIT NUMBER
REMARKS in
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
31 [3 YES [:I No
SPECIAL -INSPECTOR REQUIRED OCCUPANCY GROUP
YES NO
PLAN CHECKED BY
REMARKS
Valuation Fee Receipt No.
PlanCheck No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE I I -=C-CM I.,---.<-770
ATT]ENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY TIrLE
WORK NOTED uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
INSPECTION --15-1RECTOR'S SIGNATURE
DEPARTMENT
CITY OF 4�e��
DATN
EDMONDS "'1101
PR 6-1107
FILE