680252.pdfBUILDING
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DEPARTMENT
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PERMIT APPLICATION
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STATE LICBNSE NUMBER-
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Legal Description of Property (Show Below or Attach Four Copies)
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NEW
RESIDENTIAL GAB
LINE
DADD
NON-RESIDENTIAL D SIGN
RETAINING
WALL
DEMOLISH
EXCAVATE
FENCE
ALTER
OR FILL
( .......... X ..........
REPAIR
F_1 PRE -MOVE
INSP.
SWIM
POOL
A
DWELLING
UNITS
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I hereby acknowledge that I have read this application; that the in-
formation given to correct; and that I am the owner, or the duly author-
lzed 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; I%IOVED-IN BUILDINGS ahall be com-
pleted In six months.)
�214 1 � — 6 —
NOTE: APPlicant Subject to Plan Check Fee
This emit coven work to he done on private property ONLY.
Any construction on the public domain (curbs. sidewalks, driveways,
marquees, etc.) will require separate permission.
ISTED ON KROLL MAP NO.: PERMIT
NUMBER 680252
B ADDRESS
34 0 r7
51DE YARD SETBACK
STREET SETBACK
REAR YARD SETBACK
USE ZONE
LOT AREA
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1
[3 YES 0 NO
FIBIGHT
BUILDING AREA
VARIANCE NUMBER
PLOT PLAN APPROVED
STREET R/W
EXISTING STREET R/W ............ FT.
DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ..... ...... FT.
....... .... IV.
0
REMARKS
CHECKED BY
METER SIZE
SERVICE SIZE CLEARANCE
CHECKED BY
I
REMARKS
TYPE CONNECTION
VERIFIED BY
PERC. TEST
PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION
STREET IMPROVED
13 YES [3 NO
SPECIAL INSPECTOR REQUIRED
GROUP
[] YES [] NO
JOCCUPANCY
PLAN CHECKED BY
Fee I Receipt No.
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
e-_P
ATTENTION
THIS PERMIT
AUTHOR11ZE8
ONLY THE
WORIC NOTED
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-
Imowledged in space provided.
INSPECTION DIRFUC70R'S SIGN
DEPARTMENT
CITY OF DATE'
EDMONDS
PR 0-1107
FILE
I
H=
. � 1_____ __ , I
RECORD OF IN.SPECTIONS
Date Passed
Foundation
Plumbing (Partial)
(Rough)
Frame
Furnace & Fuel Lines -
Final
RECORD OF INSPECTIONS
Date Passed
Drainage
Sewer
Parking
Landscaping
Fire Dept.