710189.pdf,
POSTED ON KROLL MAP NO.: PERMIT 710189
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BUILDING DEPARTMENT Applicant FinNUMBER
PERMIT APPLICATION Inside Heavy Linea JOB ADDRESS
NAME
s S }} FORQ � S�-L U SIDE YARD SETBACK I STREET SETBACK I REAR YARD SETBACIC
,r MAILING ADDREBB !�
LOT AREA VACANT SITE ,
o, 8o x 133 7 USE ZONE NO
CITY TE1'LEPHONE NUMBER I I ❑ YES ❑
OVA), / �3—IW S� HEIGHT I BUILDING AREA I VARIANCE NUMBER
w00,0
NAME
PLOT PLAN APPROVED
O
p ADDRESS i
STREET R/W `..
TELEPHONE NUMBER
CITY EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT. 0 :
REMARKS '
NAME
-
- !d ADDREnn � .
I U I W 0 A 3 0 �•• A, CHECKED BY I
TELEPHONE NUMBER -
CITY
p 2(4 fit,)�DO0 METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
STATE LICENSE NUMBER CITY LICENSE NUMBER I I I PA
REMARKS � ,
Legal Description of Property (Show Below or Attach Four Copies) I
TYPE CONNECTION (VERIFIED BY
x � +
c I
r (y PERC. TEST I PERMIT NUMBER
' Uto ra$j f
W REMARKS m
47 FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
ri I I ❑ YES ❑ NO
SPECIAL INSPECTOR REQUIRED (OCCUPANCY GROUP
GAS
❑ YES ❑ NO
RESIDENTIAL LINE PLAN CHECKED BY
NEW
RNON-RESIDENTIAL ❑ SIGN
ADD RETAINING REMARKS
DEMOLISH WALL
EJ ALTER ❑ EXCAVATE
FENCE
OR FILL (.......... x.......... Ft.)
PRE -
SWIM
REPAIR ❑ INSP. POOL
NUMBER OF STORIES NUMBER OF
DWELLING {
UNITS (
NATURE OF ORK T BE DONE Valuation Fee Receipt No. V ,
� 1 i
.(n A As Plan Check No .....................
i
O BUILDING ,
PROPOSED USE
PLUMBING
A PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT Ec GAS LINO �
1 ,
7 FENCE i r
n 1171
SIGN I
i
RETAINING WALL iI
N _
I i
SWIMMING POOL
I � I
DEMOLITION.i;11 ;
i
PRE -MOVE INSPECTION �
EXCAVATION OR FILL
TOTAL AMOUNT DUE ]
I hereby acknowledge that I have read this application; that the In- PO
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 ,I `
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 I t
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep-
°m Y THE uty; and fees are paid, and receipt is ac- i
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED p ,
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com- knowledged in space provided. '
pleted In six months.) 4 �' '`•
SIGNATURE (OWNER OR AGENT) DATE SIGNED INSPECTION D OR'S IGNATU
DEPARTMENT
Q. /
-I % CITY OF DAT
EDMONDS�
NOTE: Applicant Subject to Plan Check Fee
PR a-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, FILE
marquees, etc.) will require separate permission. 1 '
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