680302.pdfPOSTED ON KROLL MAP NO.: PERMIT
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BUILDING DEPARTMENT Applicant FM
ITUUBER
Inside Heavy Lines
PERMIT APPLICATION
'JOBADDREBB
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680302
NAME OF BUSIN
NAAME (OR
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FE:
SIDE YARD SETBACK
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AR YARD SETBACK
—AaAlLING ADDRESS
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TELEPHONE NUMBER
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NO
,EIGHT-
BUILDINU AJVUA
rVARIANCEI NUAL
No ri H 6 rn AIV19
ADDRESS
CITY TELEPHONE NUMBER
Ch a �- I- q v �2 n s e n
C4 ADDRESS
1 !9-6 �L -7 - �r-
CITY UMB
6,:�47-7 4 t_1 CL P1_ k..7 q-5-
STATE LICENSE NUMBER CITY LICENSE NUB
0 / —/- !�
Legal Description of Property (Show Below or Attach Four Cople
El,
M f'. -
l��NG STREET R/W S.6--Irr- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W
indicated on Standard Drawing #103.
RESIDENTIAL
B
GAS
LINE
C] YES
NEW
PLAN
NON-RESIDENTIAL
[:]
SIGN
14.
ADD
DDEMOLISH
_I
E]
RETAI N7NG
WALL
REMt
0
ALTER
R
EXCAVATE
PENCE
Ft.)
OR FILL
( ........ . x ..........
REPAIR
M
PRE -MOVE
INSP.
swim
POOL
IUM13ER OF STORIE-3—
NUMBER OF
DWELLING
UNITS
N
Plan Check No ............... ....
PROPOSED USE
9-6 e r1c, e-
BUILDING
i'j
PLOT PLAN (ladle te Bunaing setuacKa, abutting site is)
PLUMBING
JOG
HEAT & GAS LINE:
PENCE
SIGN
N
RETAINING WALL
SWIMMING POOL
7r\
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given in 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 m6u-
ATTENTION
lating construction; and In doing the work authorized thereby, 110 person
will be employed in violation of the Labor Code of the State of WaAhlngton
THIS PERMIT
relating to Workmen's Compensation lnfiuraDca-
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS wh1ch
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be 00m.
pleted In six months.)
"EI—ONATURE
(OWNER OR AGENT) 1 DATE SIGNED
INSPECTION
915SU n P_
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fce
PR 6.1107
This Permit covers %vork to be done on Private property ONLY.
Any construction an the public domain (curbs. sidewalks. driveways,
maNuces, etc.) will require separate permission.
F1
L
P9
[] YES )& No
Fee
I
1 1c).59-01
No.
APPLICATION APPROVAL
TTds application Is not a pern-dt until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
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60MLMM
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RECORD 0 . F INSPECTIONS
Date passed
DrainagO-
Sewer
parxing
Landscaping
ep.t.
RECORD OF INISPECJI�QNS
Date Passed
�r-f
17 - /I--- G di -I
Foundation
plumbing (Partial)
.!kf,
(Rough)
0 J A..,/ AIJ&
—4�
Frame —La' 1� �t
Furnace & Fuel Lines I A)
Final
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