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BUILDING DEPARTMENT ApplleantFlll
PERMIT APPLICATION Inside ]Heavy Lines
NAM"R NAME OF.$1ld1a ESA)
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PERMIT
NUMBER i 1 f l368
SIDE YARD SETBACK STREET SETBACK BEAR YAR� SETBACK
USE ZONE LOT AREA VACANT B1TH
-RJ mot' I 1478 ❑ NO
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EXISTING STREET R/W
S
30
..✓�.y,`...FT.
DEFICIENCY THIS PROPERTY
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I �TELEPHONE NUMBER
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LAN BT. R/W
..�ll.!..FT.
.......FT.
1-•� /
Driveway
slopes
not to exceed those in-
dicated on Standard Drawing #103.
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CHECKED BY
f I TELEPHONE NUMBER
BY
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SIZE CLEARANCE
CHECKED
rE LICENSE NUMBERQ
CITULICENN�SE NUMBERI
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o[ Property
(Snow Below or Attach Four Coplea)i
�ntL�.Descrlption
1/„Y
/f-70
11
-INEW
SIDENTIAL
❑LINEN
GAS
❑ ADD
-RESIDENTIAL
:NO
❑
SIGN
D7ING
ElDEMOLISH
WALL
EXCAVATE
ALTER
❑
ORFULL
❑
(ENC x
Ft.)
..........
REPAIR
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PRE-MOVEO
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IUMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
10ol
F'E /V M YES NO
8 CIAL INSPECTOR &RED OCCUPAN R UP ^jam
YES /6 NO
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE
REMARKS S.
TAX SHOULD BE CODED 31.04.
/02w77C4L To LI -11 3 ST,
3(0S J, 366.
Valuation I Fee
Plan Check No .....................
BUILDING
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PLUMBING
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ndicato Building setbaC` abutting streets)
O
HEAT & GAS LINE
FENCE
.si 6..%
SIGN
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RETAINING WALL
4 N
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SWIMMING POOL
71 /0 O
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DEMOLITION
1
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PRE -MOVE INAPECTION
1
EXCAVATION OR FILL
I
No.
TOTAL AMOUNT DUE
I hereby acknowledge that I have lead this application; tbat the in- / a7
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 stato laws regu- ATTENTION APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Slate of Washington THIS PERMIT This application is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED Uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com- Imowledged in space provided.
pleted in six months.)
IIGNAT RE (OWNER OR AGENT) DATE SIGNED INSPECTION DIRECTOR'S ONATU
DEPARTMENT
# e'--y e / CITY OF
EDMONDS DATE
NOTE: Applica)lt uhject to Plan Check Fee —��G—
PR a-Iloy
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, FILE
marquess, etc.) will require separate permission.
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RECORD OF INSPECTIONS
I ate Passe
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Foundation
Plumbs o
` ( Plumbing (Partial) Cam/
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Furnace & Fuel Lines
Final
RE
CORD OF INSPECTIONS '
Date Passed
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Drainage ..
Sewer ..
Parking ;
..,.Landscaping ... .. ,,.
Fire Dept. !
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