690238.pdfEMT
I OUILUIMU Ugrilinl Applicant FIB
, 1, PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
&r,X2, �e I ksdal
MAI DRAB
2o43 North 78th
BL 1-2-ez: 1 6 S_
or Attach Four Copies)
Pnwrrin 6—NKROLL MAP NO.: PERMIT
W I NUMBER 690238
— I Q(;th S.W.
EXISTING STREET R/W ........ ... FT -
COMP. PLAN ST. R/W ............ FT-
REAR YARD SETBACK
VAC:T SITE-1 : 0 P4
[r] YES 13 N
VARIA14CE NUMJBERCK k
DEFICIENCY THIS PROPERTY
N
Sewer
I
In
ZONE I TYPE
RESIDENTIAL
GAS [3 YES
LINE
NEW
PLAN
NON-11
SIGN
ADD
RETAINING REUAJ
WALL
DEMOLISH
ALTER
EXCAVATE
on FILL
FENCE
( x Ft.)
........ . ..........
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF
11 DWELLING
UNITS
50
t
N
I
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 -
lard agent of the owner. I agree to comply with city and state, lawn regu-
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
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DE5101JTIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be core.
plated in six months.)
X"L4
NOTE: Applicant Subject to Plan Check Fee
_i�_s —Pemat coven work to be done on prlv&U property ONLY.
Any constructiOn On the public domain (curb@, sidewalks, driveways,
ra"queem, etc.) will require sepamte perrhisslon.
[3 NO
13 YES 13 NO
All utilities to be underground
Fee I Receipt No.
rian Check No ...........
BUILDING
PLUMBING Sac, -
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIM NG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL,
TOTAL AMOUNT DUE 00
ATTENTION APPLICATION APPROVAL
THIS PEIMUT This application is not a permit until
AUTHORIZES
ONLY THE Signed by the Building Official or his Dep-
WORK NOTED uty; and fees aria paid, and receipt is ac-
knowledged in space provided.
INSPECTION
DIREOT0ZR'SGNAT
DEPARTMENT
CITY 0
DAT
EDMONDS Pie
FILE
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RECORD OF INSPECTIONS,�....
Date Passed
4,17oundation Sfmwe' 40TdAr
Plumbing (Partia
(Rough)
Frame
Furnace & Fuel Lines
Final
NO I f 77 19100
RECORD OF INSPECTIONS
I Date Passed
Drainage
Z"er
Parking
Landsca,ping
Fire Dept,