710072.pdfPOSTED ON KROL MAP NO.:
BUILDING DEPARTMENT Applicant Fin
I Inside Ilea,. Lines JOB ADDRESS
PERMIT APPLICATION
MAILING ADDRESS
81O 12th Ave. No12 Edmonds
O _-=I-TELEPHONE NUMBER
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CADDRESS
6 7848-159th Pl. No E.
CITY I TELEPHONE NU1
x Redmond 885-154
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U STATE LICENSE NUMBER I CITY LICENSE V
45455
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f.nenl ne.crintlon of Prnnertv (Show Below or Attach Four Cc
NEW
u
RESIDENTIAL
U
LINE
❑
NON-RESIDENTIAL
❑
SIGN
ADD
❑
WALLEl NINE
❑
ALTER
❑
DEMOLISH
ORFILL
❑
FENCE
x.......... Fill
El REPAIR
❑
PRE -swim
INSP.
❑
POOL
NUMBER OF STORIES
NUMDER OF
DWELLING
I
UNITS
i
PERMIT
❑ YES ❑ NO
EXISTING STREET R/W ....... -...FT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............rr- ............FT. CCy
REMARKS F
C
x
R
TYPE CONNECTION I
VERIFIED BY
PERC. TEST I
PERMIT NUMBER
a!
REMARKS
m
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES ❑ NO
SPECIAL INSPECTOR REQUIRED
YES 0 NO
(OCCUPANCY GROUP
PLAN CHECKED BY
REMARKS
Plan Check No .....................
Valuation
Fee
Receipt No.
I
O
I
BUILDING
PROPOSED USE
PLUMBING
U
aPLOT
HEAT A GAS LINE
PLAN (Indicate Building setbacks, abutting streets)
m
n
FENCE
SIGN
RETAINING WALL
N
ISWIMMING
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this 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 and state lawn 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 DEMOLITIONS which
shall be completed In ninety days: MOVED -IN BUILDINGS shall be com-
pleted In eh: months.)
iIGNATI:ltE (OWNER OR AGENT) 1 DATE SIGNED
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on privets property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORFL NOTED
INSPECTION
DEPARTMENT
CITY OF
EDBIOND$
PR S-1107
1 7e00 1 �7/t
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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3 ;RECORD OF INSPECTIONS
Date Passed
i Foundation
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"RECORD OF,INSPECTIONS
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Date :Passed:el
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Drainage
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Sewer
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Landscaping,
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