710309.pdfi
BUILDING DEPARTMENT
PERMIT APPLICATION
ZMETRU MuEss
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CITY
S
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Applicant Fill
Inside Heavy Lines
93
V.
C 7/03b9
ON KROLL MAP NO.: PERMIT
/ , / r (//_eri NUMBER
DRESS
�1. � .
ARD SETBACK STREET SETBACK .I REAR YARD SETHACN
❑ YES
ENJ
EXISTING
Gse,13 d(II
EXI8TIN6 STREET R/W ...... DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W i�a�l'7 •••.0•^FT.
Driveway 81Oyes not to exceed those indicated
on standard Drawing #103.
Legal Description of Property (Show Below or Attach Four Copies)
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T/t 5'007V
#A11C
101= TjgE,�,
y� 00
TYPE CONNECTION
I VERIFIED BY
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r/lf,E Sm uTN
1)om
g .oF ;%F
Al.
AlWe '
PERC. TEST
I PERMIT NUMBER
W
OF T I1�C`T
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REMARKS
,CaC'/4Cat� a�f
SldOf(Oof/tSf/ L'dU.vTl!'
GFi�
FIRE TYPE OF CO TRUCTION STREET IMPROVED
I ��. � I ❑ YEB � No
SPEC AL INSPECTOR REQUIRED OCCUPA,N/CCY GROUP
YES I
RESIDENTIAL
GAS
LINE
❑ ANO
BY
PLAN CHECKED
'YYNEW
Y''MMf
❑
NON-RESIDENTIAL
❑
SIGN
ADD
RETAINING
WALL
REMARKS
DEMOLISH
lbV gL
F`E_`C TM
•7
ALTER
EXCAVATE
OR FILL
FENCE
(........ ..x.......... Ft. )
REPAIR
-MOVE
a
swim POOL
UE 4�
�" R��
IRE
NUMBER OF STORIES
NUMBER F
'
DWELLING
I
UNITS
6
Plan Check No .....................
BUILDING
PLUMBING
streets)
HEAT h GAS LINE
FENCE
SIGN
tRETAINING
WALL
N
ISWIMMING
POOL
DEMOLITION
to
' \
PRE -MOVE INSPECTION
i
EXCAVATION OR FILL
NI
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this applicatioJI/nthe In-
formation given Is correct; and that I am the owner, or theauthor-
ised agent of the owner. I agree to comply with city and es regu-
ATTENTION
lating construction; and in doing the work authorized theperson
will be employed In violation of the Labor Code of the Statehtngton
THIS PERMIT
relating to Workmen's Compensation Insurance.AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOwhich
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGe com-
pleted In six months.)
816NATURE (OWNER AGENT) DATED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Cbeck 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.
;Oel J3r6D
APPLICATION APPROVAL
This application is rot a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE
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