690433.pdfI
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LL MAP NO.'. PERMIT
PFUUTEN ON KRO
NUMBER 690433
BUILDING DEPARTMENT ApplIcant Fill
Insido Heavy Line JOB ADDRESS
PERMIT APPLICATION I - I F
CITY
7Z _�4
TELEPHONE 11
AM
Al?avall
DDRESS
7a 2. I->
ITY
TELEPHONE I
rATE LICENSE NUMBER
72- _2� I- IS C> L 2� 9-
CITY LICENSI
1 ?
.ecal Description of Property (Show Below or Attach Four
MNEW
V ADD
F-1 ALTER
1:1 REPAIR
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FA
RESIDENTIAL
I
R
GA23
LINE
NON-RESIDENTIAL
El
SIGN
DEMOLISH
RETAINING
WALL
EXCAVATE
OR FILL
FENCE
( .......... x .......... Ft.)
F-1
PRE -MOVE
INSP.
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DWELLING
UNITS
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EXISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ........... 1".
0 YES
Ipwad Plan Check No....
7 11
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
tRETAINING
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read thin application: that the In-
formation given Is correct; and that I am the owner, or the duly author-
lzed 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 DE51OLITIONS which
shall be completed In ninety days; MOVEDAN BUILDINGS shall be com-
pleted IW six months.)
URE__� R OR AGENT) DATE SIGNEI)
NOTE. Applicant Subject to Plan Check. Fee
This Porn-dt covers werk to be done an private property ONLY.
Any construction on the pubito domain (curbs, sidewalks, driveways,
marquec#t etc,) will require separate pern-dasion.
rBACK
REAR, YARD SETBACK
VACANT SITN
13 YES NO
LREA
.9
I VARIANcra NUMBER 04
DEFICIENCY THIS PROPERTY
BY
[] YES Ej NO
'!OUP
S2� 03,.7
Valuation I Fee
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P4 1
Receipt No.
TOTAL AMOUNT DUE I I Ay — � I
ATTENTION APPLICATION APPROVAL
THIS PFRAUT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
WORE NOTED Uty; and fees are paid, and receipt Is ac-
Imowledged in space provided.
INSPECTION DIREI
DEPARTMENT
CITY OF
EDMONDS DATE
PR G-1107
FILE
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RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
(Rough)
Frame
Furnace & Fuel Lines
Final
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1 14-4-
RECORD OF INSPECTIONS
Date Passed