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BUILDING DEPARTMENT
Pile r"
Applicant Fill
PERMIT APPLICATION
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Inside Heavy Lines
NAME R NAME OF BUSINESS)
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MAILING ADDRESS
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TELEPHONN;ENUMBIER
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NAME
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ADDRE13S
CITY
TELEPHONE NUMBER
NAME
ADDRESS
CITY
TELEPHONE NUMBER
A
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STATE LICENSE NUM13ER
CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
--t) Aj 77
J
F1 RESIDENTIAL
GAS
El LINE
DNEW
1:1 NON-RESIDENTIAL SIGN
ElAlJ1J
RETAINING
F�
WALL
DEMOLISH
ALTER EXCAVATE
OR FILL
r—J�FENCE
( . Ft.)
......... . ..........
PRE-MOVF
REPAIR F-1 INSP.
SWIM
POOL
DWELLING
UNITS
iTED ON KROLL MAP NO.; PERMIT
NUMBER 690262
I ADDRESS
1E YARD SrTBAC STREET SETBACK HEAR YARD SETH
/0 , M;'01 K I / 5� .__ 125 / '-�; 'e
uAi; ZONE ljux ��n
0 YES 0 N
JEIGHT JJUALUING --AREA VARIANCE NUMBER
i'LOT PLAN APPROVBD
STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ F.T.
REMARKS
CHECKED BY
METER SIZE I SERVICE SIZE I CLEARANCE CHECKED BY
REMARKS
TYPE CONNECTION VERIFIED BY
PERC. TEST PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION S77rET 'IMPROV,
I 1 0 YES 13 NO
[] YES El NO
PLAN CHECKED BY
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
I EXCAVATION OR FILL
Valuation
Fee
Z
z
No.
TOTAL .],MOUNT DUE
at
I hereby acknowledge that I have read this application: that the In-
he I"-
'y ulhor-
formation given to correct; and that I am the owner, or the duly author-
aw a rc gu_
Ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
APPLICATION APPROVAL
no pe rson
lating construction; and In doing the work authorized thereby, no person
'reshington
will be employed In violation of the Labor Code of the State of Washington
T1118 PERMIT
This application Is not a permit until
relating to Workmen*s Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DIDIOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt Is ac-
shall be completed In ninety days: MOVED -IN BUILDINGS shail be com-
knowledged in space provided.
pleted In six months.)
,�JGNATURE (OWNER Olt AGENT) DATE SIGNED
INSPECTION
710
�A-'
DEPARTJ,JENT
'eZ let
CITY OF
EDMONDS
DATE
NOTE: Applicant Snbject to Plan Check Fee
PH 0.1107
This Permit covers ivork tA be done on privets property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FILE
marquees, etc.) will require separate permission.
; I
R PARTIAL APPROVAL
F-1 VIOLATION
[YCO CT-1 -BE
QUIREJ-1
PERMIT
-2
NUMBER
JOB ADDRESS
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NO PERMIT — STOP WORK REMOVE CONSTRUCTION OR OBTAIN
M PERMIT AND MAKE WORK COMPLY WITH BUILDING LAWS.
CONSTRUCTION IS NOT IN ACCORDANCE WITH APPROVED PLANS
AI�M PPRNnT — 9TOP WORK. MAKE EXISTING WORK COMPLY WITH
THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED
WITHIN ..... .... DAYS OR PENALTIES IMPOSED BY LAW MAY BE
APPLIED. FOA INS GTIONS CALL: PR 6-1107.
INSPECTION
DEPARTMENT
INSPECTOR BUILDING CITY OF
PLUMBING EDMONDS
DATE
xk- L
plumbing (Partial)
(Rough)
Frame
Furnace & Fuel Lines -
Final
RECORD OF INSPECTIONS
Date Passed
Drainage
Sewer
Parking
Landscaping
Fire Dept.