710083.pdfi
BUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Linos
.�i NAME ( YHOtlii3.�
Ce %%Y e S f"i //�r
11AILINO ADDRESS
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�•„ ° CITY_ /I TELhPHONE NUMBEn
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POSTED UN KROLL MAP NO.: T 0083Ou[�PFERMI
UMBER;(i
JOB ADDRESS
BIDE YARD SETBACK STREET SETBACK I REAR YARD SETBACK
UB' NE I LOT AREA I VACANT 81TH I
YE8 3 NO
HEIGHT I BUILDING AREA VARIANCE NUMBER p,
i
STREET 1t15v
EXISTING STREET R/W O..FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W Y�'....FT. •••••FT•
REMARKS
Driveway slopes not to exceed those indicated
on standard drawing #103 _
CITY LICENSE NUMBER%n pW�
or Attach Four Copies) REMARKS /,e..
exceeds k0a si vne, yt
TYPE CONNECTION (VERIFIED BY
Q PERO. TEST I PERMIT NUMBV
REMARKS . 1 ♦ 1 A 1\ I rr \►\). W
®RESIDENTIAL
NEW
GAS
LINE
❑
NON-RESIDENTIAL
❑
SIGN
❑ ADD
RETAINING
❑
DEMOLISH
El
WALL
EXCAVATE
ALTER
❑
ORI'ILL
(ENCx
Ft.)
❑ REPAIR
ED
PRE -MOVE
O
..........
SWIM
7 MBER OF STORIES
I NUMBER OF
DWELLING
tst
/
UNITS
PATURE OF WORKe .� O BE DONE' N er _ -A ') J C.1d C, 7 )
L" Qj
'v I [] YES 7K7. NO
SPECIAL INSPECTOR REQUIRED IOCCURY IFUPP I
El YES �>6 NO
Plan Check No .....................
BUILDING
PLUMBING
BEAT do GAB LINE
FENCE
SIGN
tRETAINING WALL
IBWIMMIN6 POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given to correct; and that I am the owner, or the duly ¢uthor-
lzed agent of the owner. I agree to comply with city and elate 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 Slate of Washlagton
THIS PERMIT
relating to Workmen's Compensation Insurance•
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shalt be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
a
) j
DEPARTMENT
.•r.
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
rR a-IIo7
This Permit covers work to be done on private Property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation
Fee Receipt No.
i
1114 0
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.
FILE
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F'INSPE TIONS
RECORD O. C_
t,• Date Passed
Foundation
.._ :- 7/
plumbing (Partial) —
It
(Rough) l
!.: a„ -_
Frame
Furnace & Fuel Lines 71 IIA/
Final
itECORD OF INSPECTIONS
Dater Passed
I.
Drainage ' '
Sewer
Packing
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-,Landscaping,
Fire Dept..: ------ .
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