710098.pdfPOSTED ON KfiOLL MAP NO.: PERMIT 10098
s Applicant Fill NUMBER
r„ y BUILDING DEPARTMENT �
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
NA
SIDE YARD SETBACK eTREE BE BACK I REAR YARD SETBACK ;
MAILING AD ESQ _ D I
•� U8 E LOT AREA VACANT SITE
Q�jfl
' t .CITY _. N HVILD
TELEPHONE NUMH1iR /�. / I YES -. ❑ NO !
HEIGHT1-/—r - I6 AREA VARIANCE NUMBER rat II
u,► 'LJI I
I4AMID _
PLOT PLAN APPROVED
...,. ) 'ADDRESS _ 1
STREET R/{V _
_.
! 0 - TELEPHONE NUMBER EXISTING STREET R/W ..........FT. DEFICIENCY THIS PROPERTY.
g CITY. COMP. PLAN ST. R/W ............FT. ...... ...FT. a j
REMARKS
AME :.
' K /1—
J ' • F- CHECKED BY W
/ /
qpd.. t Cl Y TELEPHONE NUMBER - kk
z C�"�' LJcY�ti I �m 6,0� METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
_.
STATE LICENSE NUMBER CITY, LICENSE NUMBER D:
REMARKS
Legal Description of Property.. (Show Below or Attach Four Copies)
} TYPE!CONNECTION - -- - VERIFIED BY
PERC. TEST - - - - - -- - I PERMIT NUMBER Q,
REMARKS
47 FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED-
. DYES NO
SPECIAL .INSPECTOR REQUIRED 'I OCCUPANCY GROUP '
_._ _.. GAS ❑ YES NO
El NEW
RESIDENTIAL Er LINE PLAN CHECKED BY _....
NON-RESIDENTIAL ❑ SIGN
ElADD ❑ RETAINING REMARKS
DEMOLISH WALL
ALTER ❑ ORFILL
EXCAVATE ❑ FENCE x.......... Ft.
)
Ej REPAIR PRE -SWIM
❑ INSP�fOVE ❑ POOL
NUMBER OF STORIES I NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE y/. q Valuation Fee Receipt No.
�� A 5 r4 /I new C w j/ et 5 Y N i /i Oy r G.� Plan Check No .....................
zJ BUILDING
,frl
4 PROPOSED USE
PLUMBING
U
aPLOT PLAN (Indicate Building setbacks, abutting streets) HEAT do GAS LINE
FENCE
SIGN
1 RETAINING WALL
N
I SWIMMING POOL
DEMOLITION
i
PRE -MOVE INSPECTION
i
I
EXCAVATION OR FILL -
I
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-
Ized agent of the owner. I agree to comply with city and state laws regu- ATTENTION APPLICATION APPROVAL
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 This application is not a permit until
relating to workmen's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ae-
shall be completed 1n ninety days; 31OVED-IN BUILDINGS shall be com- knowledged in space provided.
pleted In six months.) .
SIGN TURF (OWNER OR AGEN DATE SIGNED INSPECTION DI OR'S SfpNATU i/f
I l b /�l DEPARTMENT
;,'wc�r
CITY OF �
EDMONDS DATE �
NOTE: Applicant Subject to Plan Check Fee PR salon
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, FILE
i
marquees, etc.) will require eel:, -rate permission.
;i
e
i
n,