680286.pdfZ
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DEPARTMENT
VL�
� PnR,Pnn nN KROLL MAP NO.: PERMIT
Applicant M
inside Heavy Lines
DNEW
FV__1
RESIDENTIAL
0
GAS
LINE
NON-RESIDENTIAL
F�
SION
ElDEMOLISH
RETAINING
WALL
ElALTER
F]
EXCAVATE
OR FILL
FENCE
( .......... x .......... Ft.)
REPAIR
PRE -MOVE
INSP.
swim
POOL
NUMBER OF
DWELLING
UNITS
INUMBER
NIS
q.-p- T -
D SETBACK I STREET SETBACK
VACANT SITE
0
[3 YES
VARIANCID/NU ER 9.
i_2�is�NG__18,T"REL7r R/W ........... XT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... ITT -
OW44M
C] YES 1p�
Plan Check No ................. .
BUILDING
ietbacks. abutting stjeets)
PLUMBING
o.3-elxl.
HEAT & GAS LINE
FENCE
t
SION
N
RETAINING WAI-1
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
17
EXCAVATION OR FILL
a 0
TOTAL AMOUNT DUE
I hereby ucknowledge, that I have read this application; that the in-
formation given to 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
relatlng to Workmen's Compensation Insurance.
AUTIIORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEAIOLITIONH which
WORK NOTED
shall be completed In ninety days; BIOVED-IN BUILDINGS shall be com-
plated in six months.)
IIGNATURE (OWNER OR AGENT) j
DATE SIGNED
INSPECTION
_�y I
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 0-1107
This Permit cove%% work to be done on private property ONLY.
Any construction a)- the public domain (curbsj sidawailkso driv&WAYso
numquees ate.) witi require sepsrato permission.
13 YES
Fee
M
APPLICATION APPROVAL
an
No.
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.
k
V;�
South 237 feet of the
West 100
feet of the East 755 fee" of the 19, Township
t quarter of Section
3t quarter of'�he Northeas
S thea,
OU
Range 4 East W.M. less roads;
27 North, h State of Washington;
ty of Snohomis"
tiate in the Coun
Si
OWING,
4
SUBJECT TO THE FOLL
s recorded tinder Snohomish County
Ln9t said premise
Mortgage agaJ
mortgage grantees assume and agree
e No. 1-564729 which
is Fil eof; righto reserved
Auditor iditions ther
to pay accoordIng to the ternij and c0T
in federal Patents or state deeds; building or use restrictions general�
ning regulations or I!
to the district; existing easements; building Or zO nohomish
t recorded under any of the following S
provisions; any matteT 1060815.
Oounty Auditorts File Numbers- 845369, 850181,
?ZIP
RECORD OF INSPECTION9
Date Passed
Foundation
Plumbing (Partial)
(Rough) 4
Frame
Furnace Fuel Lines 14)
Final
, f-4
tt
AC
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