710297.pdf--------------
POSTED ON KROLL MAP NO.; PERMIT
NUMBER
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710297
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13UILDING DEPARTMENTlll
ApplicantF
4
PERMIT APPLICATION
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NAME (OR NAME OF BUSINESS)
SIDE YARD SETBACK STREET SETBACK
REAR YARD SETBACK
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MAILING ADDRESS
US ZONE LOT AREA
VACANT BITE
TELEPHONE NUMBER
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10 TEO NO
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CITY
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HEIGHT BUILDING AREA
VARIANCE NUMBER ,
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1 NAME
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7
7
or
RESIDENTIAL
❑
NON-RESIDENTIAL
ElNEW
ADD
❑DEMOLISH
ALTER
❑
EXCAVATE
ORFILL
REPAIR
R
n
PRE -MOVE
INSP.
DWELLING
UNITS
10 J ' 9'
SIGN
ORETAINING
WALL
❑FENCE
(........ ac......... Ft. )
SWIM
I { POOL
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N
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PLOT PLAN APPROVED
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o:
STREET R/ W
EXISTING STREET R/W ... ........ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ...........•PT. ....... ...FT.
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REMARKS
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CHECKED BY
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
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REMARKS
TYPE CONNECTION
VERIFIED BY
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PERC. TEST
PERMIT NUMBER
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REMARKS
FIRE ZONE I TYPE OF CONSTRUCTION I STREET IMPROVED
YES
M
NO
LO
Plan Check No .....................
BUILDING
PLUMBING
HEAT & CAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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 -
lied agent of the owner. I agree to comply with city and state laws regu.
ATTENTION
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
TINS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In nlbety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
SIONAT ItFy (OWNER AOE DATE SIGNED
INSPECTION
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DEPARTMENT
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41
CITY OF
EDMONDS
NOTE: 45ficant Subject to Plan Check Fee
PR 6.1101
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
i7 YES
CITY OF EXIONOS. LOCAL
I'm
�200
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-
1(nowleOged in space provided. {
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