710079.pdfPOSTED ON KRO MAP NO.I
PERMIT
BUILDING DEPARTMENT
Applicant FIR
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NUMBER
PERMIT APPLICATION
Inside Heavy Lines
JOB ADDR SS _
NAME N_
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SIDE YARD BETHAOK
STREET 8�.ffiyT�H'A�CK) Rffi YARDB�ETHAOH
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PLOT PLAN APPROVED
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TELEPHONE NUMBER
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THIS PROPERTY
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EMARKS
REMARKS
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NAME
Driveway slopes not to exceed
those indicate
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ADDRE98
on Standard Drawing #103.
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REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
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TYPE CONNECTION
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PERC. TEST
IPERMI U
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REMARKS
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FIRE ZON (TYPE OE.FtONSTRUCTION
I STREET IMPROVED
8 ❑ NO
SPECIAL INSPECTOR REQUIRED
(OCCUPT
OR UP�
a_RESIDENTIAL
GAS
❑ LINE
❑ YES NO
NEW
PLAN CHECKED BY
NON-RESIDENTIAL
❑ SIGN'
ADD
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RETAINING
WALL
REMARKS
DEMOLISH
E PENCE
ALTER ❑ ORCFILL ❑ Ft.)
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REPAIR PRE-VE SWIM
� INSP. M0 POOL
NUMBER OF STORIES
NUMBER OF
DWELLING /
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UNITS
NATURE OF WORK TO BE NE
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Valuation
Fee
Receipt No.
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Plan Check No .....................
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BUILDING
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PROPOSED USE
PLUMBING
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PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAB LINE
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FENCE
SIGN
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WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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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 laws 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 Waahington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUMDINGS shall be com-
pleted In slx months.)
1IGNATURE (OWNER OR AGENT) DATE 8IGNED
�.
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY ORK xTE
ut and fees are aid, and receipt is ac-
knowledged in space provided.
INSPECTION
TIMP.N ARIA RIGINATLIRM
CITY OF
EDMONDS DATE
PR d-1107
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