710549.pdf• • 1
t
MAP NO.: PERMIT i
' A ppllcant Flll
BUILDING DEPARTMENT I NUMB
1105'
Inside heavy Lines JOB ADDRESS
PERMIT APPLICATION
/ A Ir�
^' I NAME (OR NAME OF BUQINESS) /l Oa (Q / -7 l! 0 / ✓/ e
2.t
N
❑ NEW
ElADD
ElALTER
❑ REPAIR
01Q4FCI / 12Z
7W yap- it/
TELEPHONH NUMBH
76 "'A Avg It/ 4
— UT/ELEPHON/�E NUMBH
s 4,1/�"/�/ I Ll� / 3 j
MER (CITY LICENSE NUM
mperty (Show Below orttach Four Copley
A6y 4411)>_.l S,lu
SIDE YARD SETBACKSTREET SETBACK I REAR YARD SETBACK
C7
USE ZONE I LOT AREA - VACANT SITE
I Q YES 13 NO !
HEIOHT I BUILDING AREA (VARIANCE NUMBER i•Li i
PLOT PLAN APPROVED
STREET R/W
EXISTING STREET R/W ...........FT.. - DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ...........FT. ........FT.
REMARKS
0
W
0
z
w
CHECKED BY
TYPE
FIRE
SPECL
❑❑
RESIDENTIAL
GAS
LINE
❑ YES
NON-RESIDENTIAL
F91SIGN
PLAN
DEMOLISH
RETAINING
WALL
REMA:
E
EXCAVATE
ORFILL
❑ FENCE
x.......... Ft.)
f p
❑PRE
-MOVE
INSP.
swim
POOL
P�
'.IE9
NUMBER OF
y1"r
DWELLING
UNITS
•
TION VERIFIED
PERMIT NI
D
r
3Y
YPE OF CONST ON 7 STREET IMPROVISE
N YES NO
4SPECTOR REQUIRE OCCUPANCY GROUP�
NO I t-� i
— 3
c D BY THIS SITE IS LOCATED IN TF
e
Plan Check No .....................
BUILDING
&5//U,Fss
PLUMBING
HEAT & GAS LINE
ttlng streets)
1
N
FENCE
SIGN
RETAINING WALL
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 Labor Code of the Stale of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Yeur (Except DE51OLlTIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.) n
NOTE: Applicant Subject to Plats Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY TILE
WORM NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR a-1107
TAX SHOULD BE CODED 31.0
F
v
Valuation
f�L
C
W
m
No.
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-
lmowledged in space provided.
DIRECTOR' SIGNA E _�
ll �12- 7,1
i
FILE
Ii
?aMy' _.... .,.
C
�r
y
a
.. ..
r
r
f