700320.pdfI im
—BUILDING DEPARTMENT
Applicant Fill
Ppi Inside Heavy Lines
ERMIT APPLICATION
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ADDRESS
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Sam
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CITY
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crIption of Property (Show Below or Attach Four Cople;)
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RESIDENTIAL
[U
GAS
NEW
LINE
NON-11
SIGN
DA.O1
ElDEMOLISH
El
RETAINING
WALL
0 AVrER
EXCAVATE
rENCE
E] OR FILL
( .......... X .......... Ft.)
0 REPAIR
F_J
PRE -MOVE
INSP.
ET
SIVIM
POOL
NUMBER OF
DWELLING
I
UNITS
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14
I 3S
'OSTED ON KROLL
MAP NO.:
PERMIT
NUMBER700320
OB ADDRESS
SQ o.�
IDE YARD SETBACK
STREET SETBACK
REAR YARD SETBACK
USE ZONE
LOT AREA
VACANT SITE
OYES NO
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ni
IEIGHT
BUILDING
AREA
VARIANCE NITM13ER
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TTRENT R/W 6 OD
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W FIr. ..0 .. r"T.
REMARKS
Driveway slopes not to exceed those
indicated on Standard Drawing # 103.
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CHECKED BY
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
a / P 40
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REMARKS
TYPE CONNECTION
VERIFIED BY
PERC. TEST
PERMIT NUBLIMR
99
REMARKS
F65516U�- S6VJA6-1-z_ T5ACKr,(_0W rPUSI�CN
71RE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
1717 1 0 YES
_§P
CIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
YES 01<0�
PLAN CHECKED7 Ir
REMARKS
Plan Check No .....................
BUILDING
PLUMBING
)acks, abutting streets) HEAT & GAS LINE
FENCE
.15 SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR rILL
:257 /
TOTAL AMOUNT DUE
I hereby acknowledge that I havo read this application; that the In.
In'
formation given In correct; and that I wn the owner, or the duly author.
th or
Ized agent of the owner. I agree to comply with city and state laws regu-
re gu-
lating construction; and in doing the work authorized thereby, no person
"on
ATTENTION
will be employed In violation of the Labor Code Of the State of Washin gton
gt on
2]
TIUS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZE8
NOTE: Permit Limit One Year (Except DE51OLITIONS which
ONLY THE
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
co
WORK NOTED
pleted In six months.)
RWTURE (OWNER Oft DATE SIGNED
INSPECTION
DEPARTMENT
0
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6.1107
This remit coven work to be done an private property ONLY.
Any construction an the public domain (curbs, aldews.1lim, driveways,
marquees, etc.) will require separate permission.
Valuation
4
Fee
RM M011
No.
APPLICATION APPROVAL
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.
FILE
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