680303.pdf..... ..... .. . . ......
FBUILDING DEPARTMENT Applicant Fill
Inside Heavy Lines
PERMIT APPLICATION
OR NAME OF BUSINESS)/ -
NAME
I
JJTATZ L
,,Legal Dej
- /1 -11 -)
NEW
RESIDF:NTIAL
GAS
LINE
El
II:TON-RESIDENTILAAL
M
F]
SIGN
DADD
RETAINING
DEMOLISH
WALL
DALTER
EXCAVJkTE
PENCE
D
OR FILL
( x Ft.)
El REPAIR
PRE -MOVE
INSP.
........ . ...... ...
SMM
POOL
NUMBER OF
DWELLING
UNITS
P NO.:
PERMIT
NUMBER
a) .
I I __10
USE ZONE LOT AREA VACANT SITE
YES NO
I RUILMING AREA I VARIANCE NUMBER
E3C[STING-STnEET R/W ........ ... FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ........ .. ST. .... ....... FT .
[] YES EJ NO
plan Check No ............. ... ...
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks. abutting streets)
PLUMBING
HEAT & GAB LINE
PENCE
t
SIGN
RETAINING WALL
SWIM NG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given is correct; and that I am the owmer, or the duly author-
Ized agent of the owner. I agree to comply with City and state laws regu-
ATTE3MON
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
THISPEUMIT
relating to Workmen's COMPOUB811OU Insurance.
AUTHORJIZES
NOTE: Permit Limit Ove Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUXIMINGS shoal be com-
pleted In six months.)
SIGNATURE (OWNER OR AGENTr- DATE SIGNED
INSPECTION
")q_A_.JL_a llj'M �Z-
DEPARTMENT
CITY OF
sman�
EDMONDS
NOTE: Applicant Subject to Plan Ckeck4Fee
PR 0-1107
This permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks. driveways,
caarqueesp etc,) will require separate permission.
Valuation
13 YES 13 NO
Fee
6f
0
I
Go
No.
a.
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.
WURE
DAq%
FILE
It I., I
If
It
� 11 It P..
Ilk t ti
tv tt, �pit t&o
4,4, 1
I tf�b
t
�`4
- it. k
k4 I
tft,
k; it
ip
P.
I p #t
4' i4 2 If
tI.
jt'I 1-1 1 1,
',11� -
X
11 Ir It p
14 1 ItIO.JL.
It. %I I I— 1' 1, 1 t,' I - I " I , r, t- % I , - I ."
At - It -ttfl t
I it Int, 1, !,tt,
Iw �e 11 -5. t
r, , , mtf- tI � t
I I 'ot" 4
I p
Is It 1, 1 If I
RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
(Rough)
Frame
Furnace & Fuel ILine
Final f,
If
'tt, III