700221.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
i *-, /f C�,V,
h_17164U d6vith
NCITY TE
MI] n
W /� e &,,,
W-11,
or
RESIDENTIAL
M
GAS
LINE
NEW
1
16
NON-RESIDENTIA�Lj
M
SIGN
RETAINING
WALL
ALTER
DEMOLISH
EXCAVATE
OR FILL
PENCE
( x Ft.)
.......... . ........
REPAIR
PRE -MOVE
INSP.
swim
POOL
DWELLING
UNITS
PROPOSED USE
Q
PLOT PLAN (Indicate Building setback
0
ft Q.0k
NO.:
WWI 104-M
s -K
EXISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ FT.
C] YES
REMARKS
TYPE OF
0 NO
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
itting streets)
tRETAINING
PENCE
SIGN
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application: ihat the In.
formation given In 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.
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
TIUS IIERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shalt be com-
pleted In mix months.)
iIGN ER OR AG DATE SIGNED
INSPECTION
DEPARTMENT
_29 ;76)
CITY OF
0
EDMONDS
tl
NOTE: Applicant gi7tbject to Plan Check Fee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curb@, oldewalkso drivewaYs,
marquees, etc.) will require separate permission.
PERMIT
NUMBER
700221
1 A_) 6
A.R YARD SETBACK
/ 4'
,CAVT SITE
YES 0 NO Z
,RIANCE NUMBER
DEFICIENCY THIS PROPERTY
BY
STREET IMPROVJ
[] YES [3 NO
Fee
M
1-
14
Z
14
No.
1 6 0 0 1 ��B
APPLICATION APPROVAL
This application Is not a permit until
eigned by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
'-.10
FILE
I
Irv"
'T
L
4�O
re.1 Isc,
e.
RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
(Rough)
.... . .......
....... '06
'Furnace &-fuel'Un
�Flna
1, z
RECO
RD-OF I
NSffCTj0N
"o,
Date!Pass6d�
Y4
Drainage.
Sewer
farking.
T I-) -'A
Landscapjqg,,�
[L ....... ...... —
tflre Dept