710486.pdfr
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POSTED ON KROLL MAP NO.: PERMIT
'-BUILDING DEPARTMENT
Applicant F[ll
NUMBER 710486
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.PERMIT APPLICATION
Inside heavy Lines
JOB ADDRESS _..
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NAME
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SIDE YARD SETBACK STREET SETBACK YARD SETBACK
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USE ZONE LOT AREAVACANT BITE
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TELEPHONE NUMB&R
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NUMBER
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HEIGHT BUILDING AREA -. VARIANCE
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PLOT PLAN APPROVED
STREET R/W
EXISTING STREET R/W .FT. DEFICIENCY THIS PROPERTY
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TELEPHONE NUMBER
R/W ........FT.
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COMP. PLAN 8T. ......... ..FT.
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REMARKS
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NAME
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CHECKED BY
TELEPHONE NUMBER
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CITY
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METER SIZE SERVICE SIZE CLEARANCE CHECKED HY
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
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REMARKS
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Legal Description of Property (Show Below
or Attach Four Copies)
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TYPE CONNECTION VERIFIED BY
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PERC. TEST PERMIT NUMBER
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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❑ YES ❑ NO
SPECIAL INSPECTOR REQUIRED.: GROUP
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GAS -
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(OCCUPANCY
❑ YES ❑ NO
PLAN CHECKED HY
❑ NEW
NON-RESIDENTIAL ❑ SIGN
❑ ADD
RETAINING
❑ WALL
REMARKS,,
DEMOLISH
11 ,�// ��°°
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ALTER ❑ EXCAVATE
`�-- OR FILL
FEE
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PRE -
❑ REPAIR ElN
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P.
POOL
DWELLING
UNITS
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Plan Check No .....................
BUILDING
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a� PROPOSED USE
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PLUMBING
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aPLOT PLAN (Indicate Building setbacks, abutting strecte)
HEAT & GAS LINE
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FENCE
SIGN
tRETAINING
WALL
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ISWIMMING
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 In 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 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
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed In ninety days; aIOVED-IN BUILDINGS shall be com-
pleted In el months.)
SIG (OWNER 0 GE DATE SIGNED
INSPECTION
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DEPARTMENT
CITY OF
EDAIONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-II07
This Permit curers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation I Fee
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A3 4-2 1 e,330
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.
DATE
FILE
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