670236.pdfBUILDING DIIARIMINI Applicant Fill
PERMIT APPLICATION inside Heavy Lines
NA../,.. NAME OF liy.�INEShg 41
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CITY
or
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t
LL MAP No.:
r C_ 001*�
PERMIT
NUMBER
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7/19-
,RD SETBACK STREET SETBAC
/Vj ; Ki 1 42S7 1771
VACANT SITE
13 YES C3 240
VARIANCE NUMBER Ck
—
STREET R/W
EXISTING STREET R/W FT.
DEVIcrENCY THIS PROPERTY
WUM BSK--
...
comp. PLAN ST. R/W4.0 .... FT.
...
REMARKS
METER SIZE SER C IZE CLEARANCE I C19� BY
TUMBER
�y
44 I I
Vies) M TZ— -
PERC, TEST -PERBUT AQBER
0 YES [] NO
NEW
RESIDENTIAL
IE] 1
El
GAS
LINE
NON-RESIDENTIAL
0
SIGN
D�
r-�
RETAINING
WALT
DDEMOLISH
- ---
ALTER
El
EXCAVATE
OR FULL
D
PENCE
I X Ft.)
.......... ..........
El REPAIR
M
PRE-MOVF
INSP.
Q
swim
POOL
qUMSER OF STORIES
NUMBER OF
DWELLING
UNITS
Plan Check No ............ . .......
PROPOSED USE
BUILDING
PLUM33ING
& GAS LINE
PLOT PLAN (Indleat-013ullding setbaclo, Tbuiling streets)
SHEAT
FENCE
jSIGN
RETAINING WALL
A
SWIMMING POOL
-7K
DEMOLITION
PRE -MOVE INSPE ION
rl
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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-
ATTENTION
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
TIUS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Ilmit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; 2MOVED-IN BUILDINGS shall be com-
pleted In six months.)
R Oft AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Sjjjjcct to Plan Check Fee
PR 0-1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
caarquees, etc.) will require separate permission.
00
[3 YES [] 140
Fee
No.
1 '711 tro I a 1,10
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-
knowledged in space provided.
FILE
0
"Pit
Date Passed
Foundation
Plumbing (Partial)
64
(Rough)
,7 —.2,1 -6,7 Frame
Furnace & Fuel -
Final 70
I