680455.pdfC Ap.
BUILDING DEPARTMEN
PERMIT APPLICATION
Applicant Fill
Inside Beavy Lines
LME
-P�> u -.�_ r, R
)DRI
N. E
TY TELEPH:)NIO NUMBER
1(�ir L 5- 'Z -Z 11)
1-2-
CITY TELEPHONE NUMB
7301'L�Evue
STATE LICENSE NUMBER CITY JacErinju NVII
-2 Z-5 — 6 1 — 1917 6- 1
Legal Description of Property (Show 15elow or Attach Your COPIO
I
VMOrW. _oonAroIr
VLL_,3- PLer
Lveeec T_-)
sive,110,41,46JI ed.
aNzw
Er RESIDENTIAL
I
GAS
LINE
NON-RESIDENTIAL
OXON
RETAINING
DEMOLISH
DWALL
EXCAVATE
PENCE
ALTER
OR FILL
E]
( x 33t.)
REPAIR
PRE -MOVE
INSP.
1:1
......... ..........
SWIM
POOL
MIJER OF STORIES
NUMBER OF
DWELLING
UNITS
I
6U
I (/I W �
ADDRESS
166 144 - 7,;
Y47t!)� SETBACK I STREET
LOT
PERMIT
NUMBER
4
fs
rARD SETBACK
SITE
[3 NO
CE NUMBER
EN38TING-STREET R/W ............ M- DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ........... XT. ... M.
RZMARKS
Driveway slopes not to exceed those
shown on stariff—ard Draw:LnR #103.
[] YES
C t
9/4(t
Plan Check No .......
PROPOSED USE
BUILDING
PLUMBING 13
PLOT PLAN (Indicate Building setbacks. abutting street
HEAT & GAS LINE
FENCE
t
SIGN
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 to correct; and that I am the owner. or the duly author -
lead agent of the owner. I agree to comply with city and state laws M911- ATTENTION
letting construction; and In doing the work authorized thereby, no person
harsh
format on gv
lead as at of
letting constrt
will be employed in violation of the Labor Code of the Slats Of Washington THIS PERMIT
r I �
j,aU,lg to Workman,g Compensation Insurance. AUTHORIZES
a
ONLY THE
NOTE: Permit Umit One Year (Except DEMOLITIONS which WORK NOTED
p
ahall be completed In ninety days; MOVED -IN BUILDINGS ahall be com-
I
plated In six months.) INSPECTION
C , __
SIGNATURE (OWNER OR AGENT) DATE SIGNED DEPARTMENT
L
wwwUk" CITY OF
iL EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
ONLY.
This Permit coven work to be done On private Property
Any construction on the public domain (curb@, sidewalks, driveways,
m, uses, etc.) wtH require separate permission.
[3 YES 13 NO
Fee I ReceiDt No.
#!W-t /03. ft
113a.5(1414
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.
I '/ e-9 -- '7 � � Y I
FILE
n
FM
"-A "'A
the East
459-75 feet Of the North on"halr
The west 153,25 feet of of rucorded In
-0 Plat there
of Tract 105 lies dowdale Beach, according T
Of 44101101nish cow-Ityp 11i'atshington*
Volxvw 5 Q.r Piats�, rhte,'v, 38, records
ass and egress over. th t:outh 15
TOGLTHLR with an eauejaent for irW
A lkkkkkkkk -4�;" ..,;.
-ith at of the South half of
1, 1 1�7' ir tuid the Morth 15 f e
. ..... feet of the North ha
bed tract:
the foUowing descri to Plat thereof
dowdale Beach according
'tow
That portion of Tract 1.()5,. hea
therly extewiOn Of the E&st line of Tract Wa
East of the Sou
]Kqadcwd&lu Beach.
said Plat
nt for ingress and Qgr"$ over the Sokth 2D
TOGEMM with an easeme
running from the East line of Tract 88
feet of said Tract 1059
of the County road*
L-,0vAUj to the West line
extended
-------------
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10
i
RECORD OF INSPECTIONS -
late Passed
.Foundation lie"d
Plumbing (Partial)
(Rough)
Frame
�jj
Furnace & Fuel. LineL;
ID
Final
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