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POSTED ON KROLL MAP Not! yERMIT
BUILDING DEPARTMENT
Applicant Pill I ItI1MHPit
PERMIT APPLICATION InBido Heavy Lines JOB ADDRESS
�1
NAME (OR NAME O BUSINESS) �,a d I' / ���0 �4 y//%�P� G ��/,� KJ2 •`
8( 7y �9' M a • \ (4''A 4 SIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK
G ADDREBB �V I p-%d ' I / 0
d2 r�� 0 Fy /11 / C . ,Q 'IQ USE ZONE LOT AREA VACANT BITE '
O CITY 1 TELEPHONE UMBER S I I ❑ YES NO
�(S M D N L� Sl✓/ %i1 L V �J HEIGHT/ BUILDING AREA VARIANCE NUMBER
' NAME J O '
' PLOT PLAN APPROVED � -
ADDRESS �! '
S STREET R/W
CITY TELEPHONE NUMBER EXISTING STREET R/W PTa DEFICIENCY THIS PROPERTY
' COMP. PLAN ST, R/W 9FTa Q_FT, a `(
r• '' REMARKS
' NAMEIlk
2 % /yi
lo ' /• , et ADDRESS
L
�, + V 9Q ��J �Ci+/ �I✓71`-' C K 1 BY a 14
.
CIT TELEPHONE NUMBER ° j
op
Z. METER SIZE SERVICE SIZE CLEARANCE CIM14k 13Y
STATE LIBE LNfUpDHPRCITY LICENSE NUMBER
�I O/I I I F1 �IT
1
REMARKS
Legal Description of Properrty (Show Below orAttach Four Copies)
kD G✓•e✓L//llo i1 � }
TYPE CONNECTION E BY i 1
O c y 1
PERC, TEST I P NUM ER .1 r
. ae REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED I
❑YES ❑NO
SPECIAL INSPECTOR REQUIRED I OCCUPANCY GROUP
❑ RESIDENTIAL Li
6A8 ❑YES ❑ NO - 1
�'
❑ NEW LIxE PLAN CHECKED BY S LOCATED IN THE 1
❑ NON-RESIDENTIAL ❑ SIGN CITY OF EDMONDS, LOCAL SALES
IJII ADD RETAINING REMARKS +,.
`�C ❑ DEMOLISH ❑ WALL DBE' CODED 31.04. 1 s ' ,
❑ ALTER ❑ EXCAVATE FENCE , -
Y
OR FILL ❑ (......s......... Ft.) C .
❑ REPAIR PRE -MOVE SSVIM
❑ INBP. ❑ POOLkkeapAuf" i
NUMBER OF STORIES NUMBER OF
DWELLING
I I UNITB !qt
iIII
NATURE OF WORK TO BE DONE
I. - celpt No.
Cud ri I T Ta 1i y AJ Ab t /%iofv �
Plan Check No........_.._.......
I :,
Valuation Fee Re
z
G BUILDING o A ^I
o?� o c✓3
PROPOSED USE n
PLUMBING
A PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT A GAS LINE ;
j A
t o Q ,�• k ,Q/t� FENCEIIIA V..� SIGN ILL.i' +
RETAINING WALL '
SWIMMING POOL
DEMOLITION r
I
r r-'
PRE -MOVE INSPECTION
EXCAVATION OR FILL,,
,/# I
�9 1
TOTAL AMOUNT DUE 1'
i hereby acknowledge that 2 have rend this application; that the in,
formation given t, 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 raga. 4 l
lating construction; and In doing the work authorized thereby, no person ATTENTION APPLICATION APPROVAL
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 Io,ursace. AUTHOTHE RIZES signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORH NOTED uty; and fees are paid, and receipt is acIlk
-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com- knowledged in space provided.
pleted In six months.) •;,
81GNATS)R (OWNER ORN DATE 16N INSPECTION T !
J7 DEPARTMENT � I '
CITY OF
EDMONDS DATE
NOTE: Applicant Subject to Plan Check Fee PR alloy
This Permit coven work to be done on private property ONLY, I
Any construction on the Dubuc domain (curbs, sidewalks, driveway,, FILE
marquee,, steal will require separate permission,
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