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• POSTED ON KROLL MAP NO.: PERMIT -•,
BUILDING DEPARTMENT r'r
t NUMBER • , I r, • -, •- �
Applicant Fill
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS � � - ��� Ale-•
NA (OR NAME OF BUSINESS)
/1�-70 �s •/ U��ecz C AJ/-C SIDE YARD SETBACK I STREET SETBACK I REAR YARD BETBACI<
W ii LI Ti`/ O'7L t-
MA311NG ADDRES t7 �
7 USE ZONE LOT AREA VACANT SITE N
CITY ■ TELEPHONID NUMBER - I I 0 YES NO Z
HEIGHT I BUILDING AREA I VARIANCE NUMBER (y
NAME
F PLOT PLAN APPROVED
Cy71 ADDRESS
h STREET R/W
R EXISTING STREET. R/W ...FT. DEFICIENCY THIS PROPERTY
CITY TELEPHONE NUMDER -
' EF COMP. PLAN ST. R/W FT. .... .....I'I' tD
REMARKS - - -
' NAME114 ADDRESS
` h�"LTlVE y�lL�F2S SC2y/cE' _
?_ 2(0 ! 7 7G Ave A/ w
4 _ � I CHECKED BY
r. CITYTELEPHONE NUMBER
``�V/9ypMa4/� I
METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
STATE LICENSE DDIBEti +O/ CITY LICENSE NUMBER REMARKS I I I -
1G3 t
Legal Description of Property (Show Below or Attach Four Copies)
TYPI: CONNECTION _ I VERIFIED BY
- PERC. TEST I PERMIT NUMBER fA
W REMARKS
a
e
.Wi FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
(] YES NO
SPECIAL INSPECTOR REQUIRED (OCCUPANCY GROUP
GAB ❑ YES NO
NEW
RESIDENTIAL El LINE PLAN CHECKED BY
❑ -
NON-RESIDENTIAL SIGN THIS SITE IS LOCATED IN THE
ADD RETAINING REMARKS it (" '� r.1',.i'':•,;�, �.'t._ SALES
❑DEMOLISH El WALL 1 /A'x si io � � 0 -,- n�
ALTER ❑ EXCAVATE FENCE /� cy"`�"'�"�'-/-'`^, �%1•Lct•
OR FILL (.......... x.......... Ft,) � ' / U�
❑ REPAIR ❑ PRE -MOVE a SWIM r
DWELLING
UNITS
t
N
I hereby acknowledge that I have read this application; that the In-
formation given to 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 State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
Valuation
Plan Check No.
BUILDING
i7411)r414iL
HEAT d: GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE. INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
?,
Fee
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY TILE
WORK NOTED uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
VATURE (OWNER OR AGENT) DATE SIGNED INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR a -not
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.
FILE
I
e
I