710047.pdfBUILDING DEPARTMENT Applicant kill
Inside Heavy Lines
PERMIT APPLICATION I
NAME /I
MAILING ADDRE8S
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CITY
TELEPHONE NUMBER
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NAME
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ADDRESS
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CITY
TELEPHONE NUMBER
NAME �/Za 4 f J �`.� V ��� / • L.(./
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ADDRESS
10.23-18011; x/01
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CITY
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TELEPHONE NUMBER
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_'ffT_ATZ LICENSE NUMBER
=f7 A13-01-
I CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
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NEW ® RESIDENTIAL
NON-RESIDENTIAL
ADD ❑ DEMOLISH
EXAVAT
ALTER El ORCFILL E
REPAIR ❑ PRE -MOVE
INSP
❑
GAS
LINE
BION
RETAINING
LL
FENCx.......... Ft.)
POOL
❑
❑
(UMBER OF STORIES
NUMBER OF
/
DWELLING
UNITS
6
C
q KROLL MAP NO.: PERMIT
NUMBER
SETBACkCj I STREET SETBACK
6400 l :, As-+,, INS.
R
R. Y�, SETBACK
t
t S`
ANT SITE
ES ❑ NO
SANCE NUMBER
EXISTING STREET R/W .! "H...FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W .S,0.... FT. .. ...FT. O
REMARKS
Driveway slopes not to exceed those indicated
w
°z
on Standard Drawing #103.FQ
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�icr tZZ5 JRE 14/ 0P57RM1 t� A41AI .
FIi I TYPE O�TRUGTION STREET Ih,
_,rA ,/ (j YES
SPECIAL INSPE�R REQUIRED I OCCUPANCY O7UP
❑
YES O Z
Plan Check No .....................
—
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
TRETAINING
WALL
N
�I
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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-
ized agent of the owner. I agree to comply with city aad 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
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHOIHZES
NOTE: Permit Limit One Year (Except DE51OLITIONS which
THE
WORKYNOTED
shall be completed In ninety days; BIOVED-IN BUILDINGS shall be com-
pleted In six months.)
SIGNATU (OWNER OR A ) DATE SIGNED
INSPECTION
DEPARTMENT
�K'�—' e 71
CITY OF
EDhLONDS
NOTE: Applicant Subject to Plan Check Fee
rR s-uol
This Permit covers work to be done an private property ONLY.
Any construction on the public domain (curb@, sidewalks, drhroways,
marquees, etc.) will require separate permission.
Valuation I Fee
No.
APPLICATION APPROVAL'
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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RECORD OF INSPECTIONS
} Date Passed
Foundation
Plumbing (Partial) -- 71
(Rough) 0--7t N "L/
Frame
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,�: Furnace &Fuel Lines 41,
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Final 7�
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