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POSTED ON KROLL YAP NO.: PERMIT ; • , , . I
BUILDING DEPARTMENT Applicant Fill I I(ualBEn I Q A I n
PERMIT APPLICATION Inside Heavy Linea JOB ADDRESS
� NAME (OR NAME OF BUSINESS) q�7 O•c. Ym P/c ff U'e� 1 '�
BIDE YARD SETBACK I STREET SETBACK I REAR YARD SETBACK ,.
C1 ?
USE ZONE LOT AREA VACANT BITE
CITY CJ oL TELEPHONE UMBER 5 / I 0 YES El NO
'91OdW 7T� HEIGHT I BUILDING AREA VARIANCE NUMBER ,g7i
NAME
N PLOT PLAN APPROVED '
O�1 ADDRESS
STREET RIW
•• EXISTING STREET n/w ......»....FT. DEFICIENCY THIS PROPERTY
CITY TELEPHONE NUMBER ;
COMP. PLAN ST. R/W ............Fr. ............FT. V.
REMARKS
ad ADDRESS .<
0C a.� ,0e CHECKED BY
CITY
I ( TELEPHONE NUMBER
' $ METER SIZE I SERVICE SIZE I CLEARANCE I CHECKED BY �
STA��yTE LICENSE NUMBER CITY LICENSE NUMBER ill
REMARKS
Legal Description of Property (show Below or Attach Four Copies)
TYPE CONNECTION VERIFIED BY y
` Z
PERC. TEST I PERMIT NUMBER I
i • G REMARKS 1.
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
(❑ YES E3 NO _
SPECIAL INSPECTOR REQUIRED (OCCUPANCY GROUP
yyS�IA 0 YES ❑ NO
RESIDENTIAL figy}EE�• ❑ PLAN CHECKED DY NEW � � S SITE IS LOCATED -IN `••
NON-RESIDENTIAL SIGN CITY OF EDMONDS. LOCAL A ES
❑ ADD ❑ DEMOLISH ❑ wNING REMARKS A SHOULD BE CODED 31.0
❑ --( Q •'
ALTER EXCAVATE ❑ LL
FENCE
❑ OR FILL (........ ..x .......... Ft.)
❑ PREP -MOVE swim
POOL
REPAIR ❑ ❑
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS '
l
NATURE OF WORK TO 13EE DONE Valuation Fee Recalpt No. �
3 S 44� U-3 Plan Check No... ..»......»...
Z ”
BUILDING
PROPOSED USE
yp� PLUMBING
O PLOT PLAN (Indlrate Building setbacks, abutting streets)
n FENCE
SIGN
T I 1
1 RETAINING WALL
SWIMMING POOL I.
DEMOLITION
PRE -MOVE INSPECTION
i
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-
: (zed agent of the owner. I agree to comply with city and state laws regu• ATTENTION APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, ao parson
will be employed in violation of the Labor Code of the State of Washington THIS PERMIT This application is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZER
ONLY TID, signed by the Building Official or his Dep- - •� .
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is roe -
shall be completed In ninety days: MOVED -IN BUILDINGS shall be com• kneWledged in space provided.
plated in six months.)
SIGNATURE (OWNER it AOEN�) DATE SIGNED INSPECTION D)RE We SIGNATU
,,GGnnlYl 7/ _ DEPARTMENT
CITY OF j
EDMONDS DAT
NOTE: Applicant Subject to Plan Check Fee
PR e•I3o7
This Permit coven work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, i
marquees, ate.) will require separate permission. FILE
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