690190.pdfI
BUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAM OF BUSINESS)
4z & Ja CV"�&7 r- -.,% .. N � C- Lf ,, I r% '
Applicant F111
Inside Heavy Lines
e
,;--Get
!D ON
KROLL MAP NO
/ "2 0
PERMI
1 NUMBER
69C
DDRESS
T4
/
CV
YARD
I (h
SETBACK
t'�j .
STREET SETBACK
'?, S , M - ��
HEAR YAM
'�' -S- ,
ZONE
1�
LOT AREA
VACANT
X;zs
190
- I.. -
;��S!�LrG STREET R/W ... I DEFICIENCY THIS PROPERTY
COUP. PLAN ST. FT.
U'Sht-koc-A_Scim —5kovov Driveway siopes no-c -co exr_"_t2u Lilu-jr
------- indicated on Standard Drawing #103.
0 0 ab x 6��-2_
TE LICENSE NUMBER
? oeo*�-& C/ I /
or
-1 GAS
RESIDENTIAL F LINE
El NON-nESIDENTLJLL
SIGN
RETAINING
DEMOLISH WALL
ALTER EXCAVATE FENCE
OR FILL I ........ . x . ........ Ft.)
El REPAIR PRE -MOVE SWIM
INSP. POOL
NUMBER OF
DWELLING
UNITS
01
f I A
I
QQ
_14-f-0 I 1 (3 YES NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
[] YES �-A No I I 4it J�
0 Plan Check No ..................
D USE
;A614j:�—p
.1
BUILDING
LN (Indicate uu1ming actuacxa, abutting streets)
PLUMBING
HEAT & GAB LINE
PENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hck*tby acknowledge that I Lave read this application; that the In-
formation given is correct; and that I am the owner, or the duly author-
lzed agent of "a owner. I agree to comply with city and state laws regu-
ATTENTION
lating conatrumton; end In doing the work authorized thereby, no person
will be employed �n violation of the Labor Code of the State of Washington
THIS PERMIT
relatIng to Workmn'o Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE3101ATIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVEII�IN BUILDINGS shall be com-
pleted in six months.) 11
.
310:ZILE (OWNffR_0R AGENT)f/I
DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
do
EDMONDS
NOTE: Applicant Subjec4to Plan Check Fee
PH 6-1107
Thin Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sJdawxlks, driveways,
DuLnuecg. etc.) will rAulre sepamte locrallfild0o.
Valuation
-2i�/C t5�5DI
Fee
50 r
0 g -5� elq Y
APPLICATION APPROVAL _.-
Tills application is not a permit until
signed by Uie Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE
I
thence S. b9 W13"' be ZUUIToe IUU ULiU UIU� 1-- --
Edmonds Seaview Tracts,
lots B and C of the C. Matzen Subdivision, Tract 153
filed with the City of Edmonds Planning Commission)
as
RECORD OF INSPECTIO'NS
Date Passed
Foundation
Plumbing (Partial)
(Rough)
Frame
Furnace & Fuel Lines
Final Jj
cre, RECORD OF INSPECTIONS
----------
Date Passed
Drainage
rwy,", V-011,
Sewer
Parking
Landscaping
Fire Dept.