700263.pdf--------- -
POSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT
HUM13EIL
700263
Applicant Fill
PERMIT APPLICATION
I n
Inside Heavy Lines
JOB ADDRESS
NAME (OR NAME OF BUSINESS)
jes
SIDE YARD SETBACK
STREET SETBACK
REAR YAnij SETS
At C/
I
MAILING ADDRE138
USE ZONE
LOT AREA
VACANT SITE
YES 13 NO
CITY
it
wu;"MIONE NUMBER
&_/�"
I 4wy'vtz
HEIGHT
BUILDING AREA
VARIANCE NUAIDE
01
A
01i=.In
or
- a*x
NEW
—1
Y RESIDENTIAL
I
F-1
GAS
LINE
1 :1
NON-RESIDENTIAL
F_j
SIGN
ADD
RETAINING
El
WALL
DEMOLISH
EXCAVATE
PENCE
ALTER
El
OR FILL
E]
( x Ft.)
REPAIR
E:]
PRE -MOVE
INSP.
......... ..........
SWIM
POOL
FUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
I Z � 4
E)aSTING-STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ IT.
0 YES 0 NO
REMARKS
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
t the In'
I hereby acknowledge that I have read this application: that the In-
ou thor'
formation given Is correct; and that I am the owner, or the duly author.
wo regu-
lzed agent of the owner. I agree to comply with city and state laws regu-
ATTE ION
latIng construction; and In doing the work authorized thereby, no person
0 pe
rfion
h in I on
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
11 "h1ch
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
_om_
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
pleted In six months.)
�_GNATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Stibject to Plats Check Fce
PH 0-1107
�Thjs Permit covers work to be done on private property ONLY.
tzw construction on the public domain (curb@, sidewalks, driveways,
marquerso etcj will require separnto permission.
Valuation
[3 YES [3 NO
Fee
No.
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or Ws Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
FILE
I j
r
I It— .1
I r r
I, rI' �t I, j tI I". t
I I I ILL_ I
141. rr
rr I-
W
Ij
RECORD OF INSPECTIONS
Date Passed
L I r I - L, Foundation
L 6 Plumbing (P-)rflal)
L I I I I I III— I I I I I L
(Roug1j)
I I 1 '4, 111 1' 1 1 .1 1 1 1 1 �II I I I I I d r.I. I, . I I . I .
L Frame- I .L I—
Furnace & Fuel Lines
I , , , , 11
A�11 II. A
It Final Ilr.
L;LI , r
jP L
I
1 1 0 1 .
I I A 0 . I I I I Z,: t I .I
S
d� RECOR Q OF. IN' PECTIONS
Date Passed
It t
1. DrainageL I
I IIaIIII 11 1 1 T
Ir. I
Sew,er.
L L L L I I I
0 6 Parking
4
�r ...... Landscapingl-j.rj�,..
Fire Dept,
0
f
4
4 1
r