710489.pdf:
. POSTED ON KROLL MAP NO,: I PERMIT / I O"TV /
BUILDING DEPARTMENT ApplleantFill
PERMIT APPLICATION Inside Heavy il.inoa JOB ADDRESS
P;
NAME (OR NAME OF BUS EBB) OCI — i... N M P e- V 1 0 .1
To, 5 SIDE YARD SETBACK STREET SETBACK REAR YARD BETBAC t
ILING ADDRESS I t7
USE ZONE LOT AREA VAOANT SITE i
/rl/!V l TE PHONE MBER I I ❑ YE9 p NO
CITY
ILEIGHT (BUILDING AREA IVARIANOE NUMBER {.
NAME
1
PLOT PLAN APPROVED
ADDRESS
STREET R/W
. EXISTING STREET R/W ...........11T, DEFICIENCY THIS PROPERTY I - 1 i 40
00 CITY TELEPHONE NUMBER
COMP. PLAN 8T. R/W ............PT. ............PT. _ t7 i . .,
REMARKS
. NAME
0� ADDRESS
r� Ee6e I — I t L`� S La I CHECKED HY
. N CITY I ELEPHONE NUMBER
p 'AyNfsk METER SIZE SERVICE SIZE CLEARANCE I CHECKED BY
� ^ �ICE�NSE UM� � � � I CITY LICENSE NUMBER I
of �-t�c REMARKS
Legal Description oL Properly (Show Below or Attach Four Uoples)
\4 i-..O iZ— `(�D:C�6 TYPE CONNECTION I VERIFIED BY
C
- PERO. TEST I PERMIT NUMBER
i
. f W REMARKS
q
o.om nn.em , mvvci nm nnvamClltnminv' 1 nTnr.a Im
SPECIAL INSPECTOR RE(
OAS ❑ YES ❑ NO
NEW RESIDENTIAL ❑ LINE PLAN CHECKED BY
- NON-RESIDENTIAL ❑ SION
❑ ADD RETAI❑ DEMOLISH ❑ NINE REMARKS
WALL
. ALTER ❑ EXCAVATE
E FENCE
ORFILL _....... Ft')
REPAIR ❑ PRE -MOVE swim
INSP, El POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DON7
Plan Check No, .................
1 ��� BUILDING
PROPOSED USE l' J)
PLUMBING
S09:90 Lot A, WICL
Ci PLOT PLAN (Indicate Building Setbacks, abutting Slreats}1 HEAT d: GAS LINE
5
a FENCE
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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-
ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Lahr Code of the Btate of Washington
relating to Workmen's Compenaattoo Insurance,
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed to ninety days; MOVED -IN BUILDING$ shall be com-
pleted 14 six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLYe
Any construction as the public domain (Sorbs, sidewalks, driveways,
mnrquees, etce) will require separate Permisalone
CITY OF EDMONDS, LOCAL SAL.TAX SHOULD BE CODED 3t
E I ('
TOTAL AMOUNT DUE
ATTENTION APPLICATION APPROVAL
TIu6 PERMIT This application is not a permit until
o TH RIZE signed by the Building Official or his Dep- ; j
WORK NOTED uty; and fees are paid, and receipt is ac- I ',
knowiedged in space provided
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PRa-1101
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- RIIIIIIECORD OF INSPECTIONS ; 1lr
s .. _ Date Passed
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