710358.pdfBUILDING DEPARTMENT\\\ POSTED ON KROLL MAP NO.I
PERMIT APPLICATION Applicant
Lines
Inside Heavy nos ADDREss
NAME (OR N ErOF BUSINESS, / //� •� /
MAILINSIDE YARD SETBACK STREET
GEpI G' DREBB
0 TPHONE
ffi NUMBL;R \ USE ZTN LOTIt-k AR
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are Lr(.�NSE NUMBER I CITY LICENSE NUMBER
20
Legal Description of Property (8how Below or Attach Four Copies)
RESIDENTIAL
ID NEW
GAB
LINE
NON-RESIDENTIAL ❑
El
BION
ADD
DEMOLISH
ALTER
RET
WALL NINE
El EXCAVATE
OR FILL El
FENCE
El
(......... at»........Ft.)
REPAIR M N PRE -MOVE
'UMBER
SWIM
POOL
OF 8TORiEB NUMBER OF
DWELLING
UNITS
I hereby acknowledge that I have read this aPpllcatlon; that the In-
formation given Is correct; and that I am the Owner, or the duly author-
Iced agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the work authorised thereby, no Person
will be employed In violation Of the Labor Code of the State of Washington
relating t0 Workmen's Compensation Insurance,
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
/3-
NOTE: APPlicant Subject to Pldn Check Fee
This Yermlt coven work to be done on Prlvale Property ONLY.
Any eonstructlOo on the Public domain (curbs, sidewalks, driveways,
marquees, etc.) will require sePamte Permission.
STREET RAW
EXISTING STREET R/W ... ........ FT. DEFICIENCY THIS PROPERTY
REMARKS ............FT. •y0 , .
CHECKED BY
METER SIZE I SERVICE SIZE I CLEARANCE I CHECKEDto
SY ,
REMARKS
TYPE CONNECTION I VERIFIED BY
PERC. TEST I PERMIT NUMBER
REMARKS
FIRE ZONID I TYPE OF CONSTRUCTION
STREET IMPROVED
SPECIAL INSPECTOR RE UIRED I YES ❑ NO
G (OCCUPANCY GROUP
O YES NO
Plan Check No....».._..».._...
BUILDING.
PLUMBING.
HEAT A GAS LINE
FENCE
SIGN
RETAINING. WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
TBI8 PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR d-1107
THIS SITE IS LOCATED IP
ITY OF EDMONDS. LOCAL
TAX SHOULD BE CODED
Fee
R UpJ
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-
knowledged in space provided.
NAT, RE
FILE
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