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POSTED ON KROLL MAP NO.:
PERMIT T-7771
BUILDING DEPARTMEN T
ApplIcani Fill
FUMBMR
PERMIT APPLICATION
F,"!
Inside Heavy Lines JOB -ADDRESS
I
NAME (OR NAME USINEBS)
6
MAILING ADDREHIS
1-==&L x . �WTMPTT INFO NUM13ER
41 e.
A
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'C
or
e A -e
F7 RrSIDENTIAL
El
GAS
LINE
9
NEW
NON-RESIDENTIAL
SIGN
ElADD
D
RETAINING
WALL
DEMOLISH
DALTER
D
EXCAVATE
OR FILL
FENCE
( .......... x .......... Ft.)
REPAIR
F1
PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF
DWELLING
UNITS
E17
r�_YARD
SETBACK
BTRFINT tihilOAUK'
REAR YARD
t
E
ZONE
LOT AREA
)
A
�� -- / :�_
I
YES NO
STRRET R/w .3 1�'
EXISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ FT.
1( 1 _-y_j t (
[3 YES [] NO
OF
Plan Check No ....................
7ROPOSED USE BUILDING
U
PLUMBING
O,� ndicate Building sq�.ajlts, abutting streets)
32 1 BEAT & GAS LINE
'33
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
T
PRE -MOVE INSPECTION
1.7 EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledgo that I have read thin 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 lawn regu- ATTENTION
l&tIng construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Wasbington THIS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DE310TATIONS which WORK NOTED
shall be cornplatel In ninety days; MOVED -IN BUILDINGS shall be coin.
plated in six months.)
IGNED
SIONATU i DATE S INSPECTION
D
CITY OF
EPART?,IENT
EDMONDS
NOTE: APPlicant Subject to Plait Check Fee PR 6-1101
Thin Permit covers work to be done on private Property ONLY.
Any construction an the public domain (curbs, flidewalkso drivewaysp
marquees, etc.) will require separate permission.
DEFICIENCY THIS PROPERTY
d �
[] YES E] NO
Valuation Fee
-7 IQ 02
V
Z
Z
5 1
Z
I
M
No.
I �?,A-iro 1 39701y
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.
70
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RECORD OF INSPECTIONS
Date Passed
Foundation
milaing (Partial)
(Rough)
Frame
Line
Furnace & Fuel
Final
rv.,