670404.pdfBUILDING DEPARTMENT ApplIcant F in NUM13ER
-PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
NAME (OR NAME OF BUSINESS) e_j Al 7-
SIDE URD SETBACK I STREET SETBACK REAR
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NAME
ADDRESB
CITY
TELEPHONE NUMBER
NAM
ADDRESS
12 L79 7- (V
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CITYd
TELEPHONE NUMBER
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STATE LICENS E NUMBER
—UMBER
CITY LIUENSM N
4
Legal Description of Property (Show Below or Attach Four Copies)
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01
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El NEW
RESIDENTIAL
1 1:1 NON-RESIDENTIAL
GAS
? LINE
10
I F-1 SIGN
Li
ADD
DEMOLISH
RETAINING
WALL
EJALTER
EXCAVATE
FENCE
OR FILL
( .......... X .......... Ft.)
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
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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 State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; AIOVED-IN BUILDII%'GS shall be com-
pleted In six months.)
iIGNATURr.(OWNEA_0R ArENT) DATE SIGNED
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.) vvill require separate permission.
0404
YARD SETBACK
USE ZONE
LOT AAI�A
vAv�-r SITE
0 YES 0 NO
HEIGHT
BUILDING AREA
VARIANCE NUMBER
PLOT PLAN APPROVED
+
STREET R/W 00a 7&k4aV
EXISTING STREET R/W ..FT. DEF1y0JWjZW%.e5�OPER7T
COMP. PLAN ST. R/v/67 ........ FT. ............ 1".
, �MARxb
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CU75,71
METER SIZ E SERVICE SIZE CLEARANCE
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TYPE C ECTION
VERIF!�
VE—Ru. WNwr
PERMTN13BER
to
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROV
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SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
YES 0-fro
PLANC EC VBY_
RE�&�B
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTIENTION
THIS PERlvUT
AUTHORIZES
ONLY THE
WORIC NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
Valuation
Fee
1(-/7'7. ei -j v
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 /9-. r=
I
4
RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
(Rough)
Frame L2 - P-j
Furnace & F Z I -Z-4 eP
Final LI -C - 71