710222.pdf1308TED ON r/KOR�OO MAP NO.: PERMIT 7 10222
BUILDING DEPARTMENT Applicant Fill / I NuIIBRIt / u cL
PERMIT APPLICATION Inside Leavy Lines JOB ADDRESS
NAME (Wi-Nik3!ffi O ..
SIDE YARD SETBACK RE ETBACK REAR YARD BETBAC
ADDRESS4A go
r US ONE L AREA VACANT SITE
TO/ /HO/�NE NU k,R a I YES No
CITY
/ S LI / �p HEIGHT BUILDING AREA VAItIANOE UAMER.
NAME
F PLAT PLAN APPROVED /
OY1 ADDRESS
N STREET RIW
- " CITY TELEPHONE NUMBER EXISTING STREET n/w ............FT, DEFICIENCY Title PROPERTY
COMP PLAN ST, R/W ............IT, ............FT.
REMARKS
NAME
�Gcn-cam'
ADDRE88
f �I CHECKED BY
CITY I TELEPHONE NUMBER
A
O METER SIZE I SERVICE SIZE CLEARANCE I CHECKED BY
Gl STATE LICENSE NUMBER CITY LICENSE NUMBER
REMARKS IJ 44
' Legal Description of Property/J (Show Below or Attach Four Copies)
)A W�_ i!T ,�ly� TYPE CONNECTION I VERIFIED BY
X
PERC, TEST I PERMIT NUMBER
�WJt� r
REMARKS � p�
' �1 � /, J/Y. Al � �,/� �, R9• IJ6'l rt /.I,�RQT
FI �ZO ,I TYPE OF CO�i{ST.RUCTIOtj I STREET IMPROV]
fly/J. nN/ YES NO
SPECIAL INSPE OR REQUIRED OCCUPANCY GROUP
❑ GAB ❑ YES NO I�i
NEW ❑: RESIDENTIAL LINE PLAN CHECKED BY�
NON-RESIDENTIAL SIGN
RETAIi ADD ❑ DEMOLISH ❑ WALL
NINE REMARKS DEMOLISH [� r .
ALTER ❑ EXCAVATE ❑
FENCE *44&L Pj6XO , U UJr AW�!
OR FILL ........ .x.»....... Ft') R.j(/�
�. REPAIR ❑ IN P. swim
POOL l I • U/3C / 97a
NUMBER OF STORIES I DF WELLINO
NATURE OF WORK TO BE DONE Valuation Fee Rece
Plan Check No, ....... _...........
O�" 1 BUILDING
PROPOSED USE
PLUMBING
Q PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT A GAL LINE
of
O PENCE
n
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formatlan 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
rating 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. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In nibely days; MOVED -IN BUILDINGS shalt be com-
pleted in mix months.)
BI ATURE (OWNER OR AGENT) DATE SIGNED INSPECTION
DEPARTMENT
7/ CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR alloy
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivewayso
marqueeso eta) will require separate permission.
f .
S
APPLICATION APPROVAL I.
This application is not a permit until 1
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided, 1
DIRECTOR'S BIGNATU 1 -
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