680453.pdfI
14 POSTED ON KROL
BUILDING DEPARTMENT Applicant FUM
PFRMIT PPLICATI H I Inside Heavy Line JOB ADDRESS
NAME (OR NAME OF 13U 13)
:3_� 0 (� , M L,0 o re-7H
M A ILING ADDRES8
+ 11, 1 10/ 1) ) -7 — 7, �N' ' IA)&, S F
32
Legal Description of Property (Show Below or Attacn. kour copies)
ZO-T
I 1.� I C) L)
NEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
SIGN
RETAINING
0
WALL
DEMOLTSH
ALTER
F�
EXCAVATE
OR FILL
PENCE
x Ft.)
........ . ..........
REPAIR
1:1
PRE -MOVE
INSP.
SPOW01ML
rUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
L_
XS_
-
�RD
( I
SETBACK
- I
STREETS]
� r-- I
PERMIT
NUMBER
VACANT tJl'rrj 14
YE13
I VARIANCEI/NU ER
d1ITING'STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ........... FT.
[3 YES [] I -TO
0 YES [3 NO
Back wash and any dumping or pumping
to be carried to the sanitary sewere
Maxioum size line 1 Y11.
Plan Check No .....................
PROPOSED USID
BUILDING
Q
a
5 PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
N
RETAINING WALL
SWIMMING 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 owner, or the duly author.
ized agent of the owner. I agree to Comply with city and state laws rcgu-
lating construction; and In doing the work authorized thereby, no person
ATTENTION
will be employed In violation of the Labor Code of the State of Washington
TIUS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
E: P rmit Wit OAe Year (Except DEMOLITIONS Which
0
ho'co
ONLY THE
WORK NOTED
leted I nInet d 0; MOVED -IN BUILDINGS Shull be com.
hall ��t
I
pleted In at month
qSIGNATU
INSPECTION
DEPARTMENT
CITY OF
(0
(0 R AG5TX
DATE SIGNED
EDMONDS
MISS!
/ NOTE: APPlicant Subject to Plan Check Fee
PR 6-1107
This Permit covers work to be done on prlvnte Property ONLY.
Any construction on the public domain (curbs, Sidewalks, driveways,
marquees, ate.) will require Separate permission.
Valuation
5.�)_00 0�0
Fee
tZ
No.
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.
404/
7 2�
Z/
0
e1c
; 7AO
k WO
tt
_RECORD OF INSPECTIONS
Date Passed
Foundation 4 �/Z 70
Plumbing (Partial)
(Rough)
Frame
Furnace & Fuel Lines.
Final
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