710103.pdf}
a
_
BUILDING DEPARTMENT
Applicant Flu
PERMIT APPLICATION
Inside Heavy LIBOR
NAME --mmt
MAILING ADDRESS
?off �£
'
t?,3 2-6
e
CITY TELEEPHONE NUMBER
7 Cz�0
I
NAME -
ADDRESS -
y�l
CITY
TELEPHONE NUDSIIER
4v%1
w4
NAME -
•
ti
Cd
ADDRESS
-
07
CITY
TELEPHONE
NUM➢ER.
x
STATE LICENSE NUMBER
CITY LICENSE NUMBER
I
Legal Description of Property (Show Below or Attach Four Copies)
•
p
v
A
O
qW{�
ri
RESIDENTP:L
GAS
LINE
NEW
_
NON-RESIDENTIAL
SIGN
ADD
KING
❑
El
WALL
DEMOLISH
ALTER
EXCAVATE
❑ ORFILL
❑
FENCEx.......... Ft.)
❑ REPAIR
PRE -MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
TO BE DONE
%X//1r — 7'2/
Z
y
q PROPOSED USE
W
a PLOT PLAN (Indicate Bulidln
� �1
o �'
ZI
POSTED ON KROLL MAP NO.: PERMIT
710103
j
NUMBER
JOB � ADDRESS
-2,
BIDE YARD SETBACK
STREET SETBACK REAR \YARD SETBACK
. I p�
I
I 5 0
USE ZONE
LOT AREA VACANT SITH
7
S8 I
I YES NO
HEIGHT _ I
BUILDING AREA i VARIANCE NUMBER
.
PLOT PLAN APPROVED.
1
STREET R/W
EXISTING STREET R/W - .. .FT. DEFICIENCY THIS PROPERTY
i
1 '•
COMP. PLAN ST. R/W ............FT. ............FT•
0
REMARKB
-
I
i
pW�
z
0
z
BY
FCHECKED
METER 8I'LE SERVICE SIZE CLEARANCE
CHECKED BY
I
I I
PS
I
REMARILB
TYPE CONNECTION
I
VERIFIED BY
PERO. TEST
PERMIT NUMBER
i
W
REMARKS
[ 1
a7
I
1
1
C� UON STREET IMPROVED
FIRE ZONN, TYPE OF
►� \1
I
tYES ❑ NO
1
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
j
❑ YES NO
1
i
PLAN CHECKED DY
ob Cput�:-Q
1�
f
REMARKS
I{
i
I
i
I
- Valuation I
Fee
RecelPt No.
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
1
RETAINING WALL
N
1
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application;jhne In-
formation given is correct; and that I am the owner, or thethor-
ized agent of the owner. I agree to comply with city and staregu-
ATTENTION
latlog construction; and to doing the work authorised thereperson
will be employed to violation of the Labor Code of the State ongton
THIS PERMIT
relating to Workmen's Compenoatlon Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE51OLIwhich
ONLY THE
WORII NOTED
shall be completed to ninety days; MOVED -IN BUILDINGS com-
pleted In six months.)
IIGNATUt2E (ONNER OR ACEN DATED
INSPECTION
seIDEPARTMENT
_/th�-"�ICITY
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, etc.) will require separate permission.
60 1 S, &v
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.
!
i