700379.pdfoSTED ON KROLI, MAP NO,: PERMIT
700379
WING DEPARTMENT
BUI Applicant FM
NUMBER
inside Heavy Lines
PERMIT APPLICATION
JOB ADDRESS
NAME (OR NAME 0 INESS)
SIDE YARD SETBACK blnz�L DEIBACK
REAR YARD SETBA
RESS
20"�
USE ZONE LOT AREA
—VA—CANT SITE
3030 .9&4 iA C'
CITY W TELEPHONE NUMBER
12,51-1 - 4 6 a Z
HEIGHT BUILDING A.—REA
(3 NO
YES --_
VARLANUE NUMIFEI
NAME
PLOT PLAN APPROVED
ADDRESS
STREET R/W
EXISTING, STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
CITY TELEPHONE NU�BER
COUP. PLAN ST. R/W ..... ....... FT-
............
REMARKS
NAME C9 x1e,
94
DO 8
KED BY
C TELErnurlE NUMBER
a5c:!��
/
METER SIZE SERVICE SIZE CLEARANCE
BY
STATE LICENSE NYMBEH CITY MCENSE "UMBER
I
ICRECKED
22 3 02. WS-1
REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
TYPE CONNECTION VERIFIED BY
a 0
PERO. TEST PERMIT NUMBER
Q
REMARKS
CAf :5C-W6V—
FIRE ZONE TYPE OF CONSTRUCTION
STREET IMP
I
10 YES 13 NO
SPECIAL INSPECTOR REQUIRED
[] YES 0 NO
OCCUPANCY GROU12
GAS
NEW RESIDENTIAL LINE
NON-RESIDENTIA SIGN
ADD RETAINING
UlDEMOLISH WALL
ALTER EXCAVATE FENCE
1:1 OR FILL ( ........ . x .......... Ft.)
REPAIR PRE -MOVE swim
11 INSP. POOL
PLAN CHECKED BY
REMARKS
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Plan Check No .....................
Valuation
Fee
BUILDING
PROPOSED USE
PLUMBING
HEAT & GAS LINE
PLOT PLAN (Indicate NuildIng set6acks, abutting streets)
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
TOTAL AMOUNT
n-
I hereby acknowledge that I have read this application; that the in-
.2
D
formation given in correct; and that I am the owner, or the duly author-
u -
ized agent of the owner. I agree to comply with city and state laws regu.
nl(
ArMNTION
APPLICATION APPROVAL
0 n
lating construction; and In doing the work authorized thereby, no person
7 :
on
will be employed In violation of the Labor Code of the Slats of Washington
US ERM
THIS PERMIT
T
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
AUTHORIZI
signed by the Building official or his Deli-
NOTE: Permit Umit One Year (Except DEMOLITIONS which
JVW
ONLY THE
WORK NOTED
7A
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.)
E T) DATE SIGNED
INSPECTION
D
It 10
DEPARTMENT
ITY OF
C CITY
DATE
NOTE: Applicant Subject to Plan Check Fee EDMONDS
PH 6-1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs# sidewalks, drIvewa7m,
FILE
marqueesp etc,) will require separate permission,
..........
BEST AVAILABLE COPY