700412.pdfXIJ4 17
1� 61 Z�
POSTED ON KROLL MAP NO.: PERMIT
7004 12
BUILDING DEPARTMENT
Applicant Fill
164% &�� N'UMBER
PERMIT APPLICATION
Inside Heavy Lines
jon —ADDRESS
L7
/.5;- C) rLWA
NAME
C�2
SIDE YARD SETUAU brREET SETBACK
'1
HEAR YARD SETBACK
17
eauc g
1
q S
5-
o
MAILING ADDRESS
.2
USE Low AAUGA
VACANT SITE
$,?-ZA
zwk
CITY
�Val"�Av
/f �
0 YES Y—N 0
rz
`7 1- 7
BUILDING AREA
NUMBER
1) i,,,a 1v
14AME
ITLECTPLAN APPROVED
ADDRESS
ra
_9FL�LEPHONE
STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
CITY
NUMBER
COMP. PLAN ST. R/W ............ FT.
............
REMARKS
NAME
"Driveway Slopes not to exceed
those indicatie,
on Standard Drawing #103.
C4 ADDRESS
V��Y
CITY
I �TRLRPRONE INUM13ER
)v
(I) I
Z
81
METER SIZE I SERVICE MIZE I CLEARANCE
Clfk"'Wy
I
.......
Legal Description of Property (Show Below or Attach Four Copies)
Lckp�e go 0 cc 4 140..I�,,
A:i,
TYPE CONNECTION
VERIFIED BY
C,1— 1_�rLrw a)C
PERC. TEST
PERMIT NUMBER
.1-2(
JQ C 0,f 3 + WJ
REMARKS
/j/
FIRE ZO TYPE OF CONST UCTIO
STREET IMPROVED
YES NO
SPECIAL INSPECTOR REQUIRED
E] YES NO
_)6
TOCCUPANCY GROUP
Ir
2;
CA
LI 7
RESIDENTIAL NE
NEW NON-RESIDENTIAL SIGN
ADD RETAINING
DEMOLISH H WALL
ALTER EXCAVATE PENCE
OR FILL ( .......... x .......... Ft.)
REPAIR PRE -MOVE SWIM
INSP. POOL
PLAN CHECKZD BY
REMARKS
NUMBER OF
DWELLING
UNITS
rian check No .....................
Valuation
Fee
Receipt No.
NATURE OF WORK TO BE DON4
BUILDING
0
PROPOSED USE
PLUMBING
PLOT PLAN (Indl cato Building setbacks, abutting streets) HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the in- TOTAL AMOUNT DUE
formation given to correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state lawn 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 PERMIT
relating to Workmen's Compensation Insurance. AUTHOIUZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MoVED-IN BUILDINGS shall be com-
pleted In nix months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED INSPECTION
7 DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This Permit covers work to be done on private Property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees# e1cJ will require sepa.rate permission,
APPLICATION APPROVAL
This application is not a pernilt until
tslgned by the Building Official or his Dep-
uty; and fees are paid, find receipt is ac-
lmowledged in space provided.
DATE
70
FILE
- 7
I