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BUILDING DEPARTMENT
Applicant Fill
POSTED ON KROLL MAP NO.: j PERMITER 710380
`
PERMIT APPLICATION
Inside heavy Lines
4 A
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JOB ADDRESS
NAME (OR NAME OF BUSINESS)
4
SIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK
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MAILING RESB
USE ZONE LOT AREA VACANT SITE
I [� YES ❑ NO
HEIGHT SUILDINO AREA VARIANCE NUMBEP-
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CITY
Ct -�•.,(r-
TELEPHONE NUMBER
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NAME
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PLOT PLAN APPROVED
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ADDRESS
STREET R/IV
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP, PLAN ST. R/W ............FT. ••••••_•FT•
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CITY
I TELEPHONE NUMBER
Id
ADDRESS
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-CITY^
STATE LICENSE NUMB]
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HONE NUMI
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or
FIRE
El NEW
ADD
❑ ALTER
REPAIR
RESIDENTIALI
NON-RESIDENTIAL
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"`fft❑"��""
LINE
SIGN
RETAINING
WALL KING
FENCEx.......... Ft.)
POOL
PLAN
❑
❑
REMA]
El
El ORCFILLTE
PRE-WIM
❑ IN P.
❑
IL'MBER OF STORIES
NUMBER OF
DWELLING
I
UNITE
❑ NO
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
N
ISWIMMING
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 rogu-
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.) I
NOTE: Applicant Subject to Plan 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.
STREET IMPROVED
❑ YES ❑ NO
THIS SITE IS LOCATED IN THE
'ITV np EDIVI NDS , OEM Sa, rt
TAX SHOULD BE CODED 31:04.
Valuation
Fee
TOTAL AMOUNT DUE
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ATTENTION
ATTENTION
APPLICATION/
APPLICATION APPROVAL
TINS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY TILE
WORK NOTED
uty; and, fe s are paid, and receipt is ac-
knowle 11t ce pr d
INSPECTION
D1Ii�
DEPARTMENT
P r . ' •.
CITY OF
T'�'' -
DATE
EDMONDS
PR 6-1107
FILE
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_.. RECORD OF INSPECTIONS
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ILEDate Passed,
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Foundation
Plumbing (Partial) I
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} RECORD OF INSPECTIONS- i
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y I Date Passed
iflt7 f t e •Drainage
Sewer` R,
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