700284.pdfF —BUILDING DEPARTMENT Applicant FBI
I PERMIT APPLICATION I Inside Heavy Lines
973
�BACK
.4 f
STRErT R/W
CITY _7��ONE NUMBER EXISTING STREET R/W ... ........ FT -
COMP. PLAN ST. R/W ............ FT-
Cd
DDRESS
CITY
mumn
METE
STATE LICENSE NUMBER
CITY LICENSE NUMBER
I
REMA
Legal Description of Property (Show Below or Attach Four Copies)
TYPE
Z
PERO
M
FIRE
NEW
RESIDENTIAL
El
AS
GIVE
NON.RESIDENTI=ALj
r 1
SIGN
RETAINING
DEMOLISH
WALL
ALTER
F1
EXCAVATE
OR FILL
PENCE
( �x Ft.)
......... . ........
REPAIR
PRE -MOVE
INSP.
swim
POOL
DWELLING
UNITS
C] YES
PERMIT
NUMBER
0 YES
700284
13 NO
DEFICIENCY THIS PROPERTY
............ ".
C] YES
NO
REMARKS 1 1
A44- erkAo--o
Plan Check No ......... ... .......
BUILDING
Z
PROPOSED USEI
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
1 hereby acknowledge that I have read this application; that 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
litting construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
10 D
INSPECTION
76)
%DEPARTMENT
CITY OF
NOTE: Applicd��t Subject to Plan Check Fee
EDMONDS
PR 6-1107
This Pennit covers work to be done on Private Property ONLY.
Any construction an the public domain (curbs, sidewalkst drIvewayst
marquees, etc.) will require separate permission.
Valuation
5 tyl
!, j"
Fee
0
No.
13 - C-6 j 15*54-1
APPLICATION APPROVAL
Vils application is not a pem-dt until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
e- ?,-<-- 7 0
Film
�Ai
....... ...
Vs
TO WHICHTHIS POLICY IS ISSU E D
-DESCRIPTION OF THE REAL ESTATE WITH RESPECT
4.
The West 125 feet of the East 300 fee t of the following described Parcels
A and B.
PARCEL A: Section 13,
Beginn ng at the.Southeast corner of Government Lot 4,
the East line of said
3 E.w.m.; thence North along
Townshio 27 N.R. el to the,South line of
600 feet parall
'lot for 8 thence West
8:.6, feet; of said lot; thence
88.6 feet to the South line
said lot; thence'South
East along the So uth.line of said lot to point of beginning, EXCEPT the
J."
South-5 feet thereof, reserved for road right of way;
PARCEL B: nment Lot� 4, Section 139.
reginning at a point on the East line of Gover
the Southeast.corner of
Township 27 N.R.4 E.W.M.., 88.6 fee t North of
Westerly and parallel to the South line
said Government Lot 4; thence
198.70 feet to the true point of beginning;_
of said lot adistance of
Westerly and paral lelto the South line ofsaid lot
nce continuing
the nd parallel to the East
f 401.30 feet; thence Northerly &
distance o 880 34"20" East
a
i line of said Lot,a distance of 12 feet; thence Sout.h
the true point of beginning.
2 feet to
4.01.4,2 feet; thence South State of Washington.
Snohomish,
situate in the County of
SCHEDULE B
MATTE RS AGAINST WHICH THE COMPANY
DEFECTS, LIENS, E NCUMBRANCES AND OTHER
DOES NOT INSURE:
SPECIAL FXCEPTIONS
L
c;-_ vz
RECORD OF INSPECT16NS
Date pas�6d
Foundation
Plumbing (pqrji al)
...... (Rougil)
Frame-
FUr*e& Fu e' I iM
Line s—,
Final
X_� -t7
16,
�.RECORD�-OF INSPECTION'S':'�"�
sse�t:�
Dat6 Pit—
Drainage
Sewer
Parking
Landsca ping
Fire Dept.