710497.pdfL..
,,:...,; .. ,.. •.. r. ..n n . .1 kr..- .. ..
..... ..... .... e _ .. r .e.n n.. _.. .......
� V-•tvYn ._�t .,::'-
v... un..rr n.^ .r.: <i
POSTED ON KROLL MAP NO.:
PERMIT NUMBER I
110`�
BUILDING
I'DC1
DEPARTMENT
AppllcantFill
I
MdY
APPLICATI®N
Insldo Heavy Linos JOB ADDRESS
NAME (OR NAME
/OOFFJBUSINESS)
E
�
ADDRESSN6
' L AIL[
i TIC7.Fpt
F
z
U
K'
POWA
or
r - IREAR YARD SETBACK ,.
V
VACANT SITE J.
i
C] YF.B [] NO 3
ARIANCE VNUMBER p�
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
N METER SIZE I SERVICE SIZE
RESIDENTIAL119 GAS
NEW LINE
NON-RESIDENTIAL SIGN
ADD ❑ DEMOLISH ❑ WALL KING
ALTER EXAVAEl OROFILLTE ❑ FENCE ..........Ft.)
❑ REPAIR WIM
❑ PRE -MOVE POOL
1Uh[BER OF STORIES NUMBER OF
DWELLING
UNITS
R
N
I
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 Labor Code of the Stale of Waahington
relating to Workmen's Compensation Insurance.
N�TE: PeMA Limit One Year (Except DEMOLITIONS which
she he corn
,pfeted n ninety days; EIOVED-IN BUILDINGS shall be com-
nle ed In alA wont s.)
NOTE: Applicant Subject to Plan Check Fee
Thls Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drlvew47s,
marquees, etc.) will regalre separate permisslon-
YES
TYPE
■
❑ YES EJ NO
THIS SITE IS LOC,'%l ED .Pt I V1,
REMARKS L t, t. S
TAX SHOULD BE CODED 31.04.
Plan Check No .....................
Valuation
Fee
I
BUILDING
PLUMBING
HEAT do GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Receipt No.
TOTAL AMOUNT DUE
I
I K
Q
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
T111s application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
THE
ORK OTT
ut and fees are aid, and receipt is ac-
knowledged in space provided.
INSPECTION
DEPARTMENT
DIRE OR'S SI TUR
(�
CITY OF
,
DATE
EDMONDS
_ PR 6-1107
FILE
0