690191.pdfDEPARTMENT
BUILDING I Applicant Fill 00
PERMIT APPLICATION inside Ileavy Lines joB ADDRE138
NAIM (OR NAME OFBUSINESB) 1�60q-
Z>ej? S 0� - AE
SIDE YARD TBACK I STREET BE
C4
,I
I
ON-
-7,7S —04 —
t
-coecp -
6--coel 1 (
0-
0 1 -.,1 -S //
77 LOT AREA
PERMIT
NUMBER 690191
VACANT HL'K19
$4'YEB (3 NO
l-VARIANCE_jTU_MJ3ER
14 V114 42 1
STREET R/ITJ -
EXISTING sVftEET RIW .6!2..FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W 4.i9..rr. ... TV.
REMARKS
Driveway slopes not to exceed those
in �icated on Standard urawing if-Lua.
-3/41-��
'�D
3
Id I I f-F
1-�- 1---0
YES [3 NO
DALTER
NEW RESIDENTIAL
I E] NON-RESIDENTIAL
ADD
DEMOLISH
EXCAVATE
OR FILL
GAS
LINE
SIGN
RETAnlMiING
WALL
PENCE
( .......... x .......... Ft.)
SPECIAL INSPECTOR REQUIRED
[3 YES Ej NO
PLAN CHECKED By
REMARKS
OCCUPANCY GROUP
REPAIR
E3
PRE -MOVE
INSP.
swim
POOL
ES
NUMBEK UF
DWELLING
V
42 e n
:s e- e-
UNITS
__ __
Ic uf- N
Q 42 'r Y
Plan Check No ....................
PROPOSED USE
BUILDING
V11A knn>
16
T PLAN (inmeate ijunding setbE�_ks, abutting streets)
PLUMRING
HEAT & GAS LINE
FENCE
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 In correct: and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state Lim regu-
ATTENTION
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
THIS PERMIT
relating to Workmen'a Compensation Insurance.
AUTHORIZES
ONLY TIM
NOTE: Permit Limit Ono'Year (Except DE51OLITIONS which
WORK NOTED
shall be completed In ninety days: HOVED-IN BUILDINGS shall be com-
pleted In six months.) q
,
It It AG DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant ?�ii Kect to Plan Check Fee
FU 6-1107
This Permit coven; work to'bo done an private property ONLY.
Any con3truction an the public domain (curbs, aldowalkst driveways,
marquees, eta.) wUl require separate permission.
Valuation
Fee
e7
No.
I 10 -b (-2p� r4k, I I rl'
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Off Icial or hIs Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
....... ...
,6 ,
RECORD OF INSPECTIONS
Date Passed
Foun
,oation
Plumbin
gll�
Frame
FurnaceA ue c2 10-V
I Lines
Final
%XNM�'
-W
:9V
RECORD OF, INSPECTIONS
-Date'Passed
Drainage
Sewer
Parking
I& ndscaping
�,Fi Dept.
M ire