690354.pdfC
BUILDING DEPARTMENT
PERMIT APPLICATION I
743
or
Applicant Fill
ImIde Heavy Lines
EXISTING STREET R/W ........... XT.
COMP. PLAN ST. R/W ............ FT.
FIRE
NEW
0 ADD
ALTER
REPAIR
RESIDENTIAL
1 1:1 NON-RESIDENTIALJ
DEMOLISH
EXCAVATE
OR PILL
PRE -MOVE
INSP.
I
El
GAS
LINN
SIGN
RETAINING
WALL
PENCE
. ....... Pt.)
swim
POOL
C] YES 0 NO
PLAN CHECKED BY
REMARKS
I
NUMBER OF
DWELLING
UNITS
Plan Check 'No ............... ....
BUILDING
PLUM33ING
HEAT & GAS LINE
PENCE
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
I EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the In-
formation given Is correct: and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws 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 DEMOLITIONS which
shall be completed in ninety days; MOVED4N BUILDINGS shall be com-
pleted in six months.)
I ev� �� I .014r I I -I � I �a
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the Public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
PERMIT
NUMBER
, L" ,
ROAR Y,
1-16—
VACANT
13 YES
DEFICIENCY THIS PROPERTY
Valuation
=4
0 YES 0 NO
Fee
1 1671 K_c
APPLICATION APPROVAL �
This application Is not a permit until
signed by tile Building Off lcial or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged In space provided.
J
.... ......
TO
ti
dr,
it
tii, :4f,
"Ir It I
CIO
feet of the folloulft described tracti
That portion of the HorUmst quarter of the NorlAw at quarter of Section 25#
Tv"hip 22"vsftrth, Range 3 Z"t.9 wemes Smhomish Comtyp Washington., described
as follow:
rn
Saidninin at a point 840 foot Xast w2d 793 foot North of Southvest co or of
1111ortWeat'quexter of Nortbareet quarterj theme North 120 feetj thence Fast IM
f*4 theme South-220-foot; theme West 120 feet to point of beginninge
RECORD OF INSPECTIONS
DAte'Passed
. ......... ......
Foundation
Plumbing (Partial)-
..... . ....
(Rough)
Frame ------
c Furnace & Fuel Line "M
S:12
Final
ij
di,
RECORD OF INSPECTI.0
Date Passed 1 ��.l
Drainage
'101
Sewer,
---7777
Parkingtt..
t Landscap!ng
t, i Fir6 Dept.".
I