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PORTED ON KROLL YAP NO.: ]PERMIT
BUILDING DEPARTMENT App,,,tP,,,, I NUMBER 710132
j) 4i; PERMIT APPLICATION Inside Ileavy Lines ,og ADDRESS
j C_uS1 0 Lot
NAME
9, /l, BIDE YARD SETBACK B ET SETBACK REAR YARD SETBACK
�441_ t d , c
MAIL IN ADDRESS
F,r•� �t �� //j USE ZONE LOT AREA VACANT SITE '
wu nu ,
OTIT TELEPHONE NtI1/Bg:R \� � (� I I ❑ YES Q NO
HEIGHT BUILDING AREA I VARIANCE NUMBER
NAME
PLOT PLAN APPROVED
STREET B/W
CITY TELEPHONE NUMBER
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY 1
- COMP. PLAN ST. R/W FT. ...Fr.-
} REMARKS
NAME ,t�' •
oq W
CHECKED BY-
,:.. F C TY I TELEPRONE NUMBER
FFFF i
METER SIZE I SERVICE SIZE I CLEARANCE I CHECKED BY .f
-STAYE LIUEN13E NUMBER CITY LICENSE NUMBER pl
REMARKS •1
Legal Description of Property (Show Below or Attach Four Copies)
TYPE CONNECTION (VERIFIED BY
PERO. TEST (PERMIT NUMBER
REMARKS
k
f FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED I
(❑YES QNO
SPECIAL INSPECTOR REQUIRED (OCCUPANCY GROUP
Q GAS ❑ YES ❑ NO
RESIDENTIAL
NEW LINE PLAN CHECKED BY
NON-RESIDENTIAL ❑ SIGN
ADD ❑RETAINING REMARKS
DEMOLISH WALL
ALTER ❑ EXCAVATE ❑ FENCE
OR FILL (........ ..z.......... Ft.)
ElPRE -MOVE swim
REPAIR ❑ INSP. POOL 1
NUMBER OF STORIES NUMBER OF - 1`
DWELLING
UNITS
NATUR OF WORK TO BE DONE Valuation Fee Receipt No. '
!� Plan Check No ............ ........
O
BUILDING
PROPOSED USE
PLUMBING �
PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT A GAS LINE O
.� FENCE -
SIGN
RETAINING WALL
ISWIMMING POOL
DEMOLITION I
PRE -MOVE INSPECTION
EXCAVATION OR FILL
i
i
TOTAL AMOUNT DUE �-�•� ) ,
I hereby acknowledge that I have read this application; that the In-
formation given to correct; and that i am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state laws rega- ATTENTION APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no person 1
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT Tills application is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZER
ONLY THEsigned by the Building Official or his Dep-
TE: Permit lmit One Year (Except DEMOLITIONS which WORK NOTED nty; and lees are paid, and receipt is ae-
hall a comDlejeTtn nett' days; MOVED -IN BUILDINGS shall be com- knowledged in space provided.
plete In six onths.)
81A is
6 ATURE OWN OR AGENT) DATE IGNE INSPECTION DI�
Oft'B (GNAT 1
DEPARTMENT r' •! ' /
Ae
/ CITY OF
EDMONDS DATE
NOTE: Applicant Subject to Plan Check Fee
PR g-1307
Tile Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, 8'ILE
marquees, etc.) will require separate permission. ,
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