710155.pdfC ,
POSTED ON KROLL MAP NO.; PERMIT 710155
BUILDING DEPARTMENT Applicant Fin � NUMBER
PERMIT APPLICATION Inside Heavy Lines J08 ADDRESS
NAME M. N.W9) SD
SIDE .y Lt ` A •MD�ID YARD BETHA K STREET i Ey�AOK RE/AR YARD
�BETu/BACH
MAILINGs•ADDRESS
1 r7.f�� ' I ! / !7 /�y✓
PjrvI Mom({ p.
UBID LOT AREA VACANT SITE
° 1 L / t �yNO
G d n'►O Nlis ff/ %4d i� %` (�° �0 e ' Ha I YEa ❑
HEIGHT I BUILDING ARHIA ARIANCE NUMBER
NAME
R W4m-i��
PLOT PLAN APPROVED
�r f {• t
ADDRESS
1
4 F I G� �J •' Y/ f STREET R/w fO
EXISTING STREET R/W S ....FT. DEFICIENCY THIS PROPERTY
CITY TIDnyEPIIE NUMBF-M
Y T/ COMP. PLAN BT. R/W 50�.,./. ...FT. ...FT. C
Ur I REMARKS ......
NAY
�,L 0 tS DrivewayQpPo � not to exceed thoce indicated
N ADDRESS _ z
on Standard Drawing Aina- W
— CH BY
��'�` 1ir�• - CITY TELEPHONE NUMBER Ij IIWjI
MET SIZE SIDRVICID SIZE CLEARANCE CH C D BY
STATE LICENSE NUMBER CITY LICENSE NUMBER S.. I ��� I I � 1y
REMARK
7ALegal Description of Property (Show Below or Attach Four Copies) (('�—•�
TYPE CONNECTION I VE Y
K _
�' L. / s `` -7
PERO. TEST
I PE I NUMBER
OREMARKS
O
FIRE I TYPE OF C0A1. ;YES
.I�,/STREET IMPROVED
'YES ❑ NO
8 L INSPECTOR REQUIRED OCC;JWCY ROUP
GAB ❑ YEB I �/
&NEW RESIDENTIAL LINE PLAN CHECKS BY/
1-1 NON-RESIDENTIAL ❑ SIGN
ADD RETAINING REMARKS
DEMOLISH WALL �/�� !/r y�
ALTER ❑ ORFILL
ID (.ENCz..........Ft.) (l (i(,���
REPAIR PRE -MOVE swim
1:1 INSP. POOL
DWELLING
UNITS
�n o i
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 Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED-1N BUILDINGS shall be com-
pleted In six months.)
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.
Valuation
Plan Check No .....................
BUILDING
14!�Wifi- 3`.I7
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
.60 J6,06
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPRO AL
TMS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
WORK NOTED
uty; and tees are paid, and receipt 18 ac-
knowledged in apace provided.
INSPECTION
................. o....,.....,�,
CITY OF
EDMONDS DATE
PH 6-1107
FILE
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RECORD OF INSPECTIONSs
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Date _ .. Passed
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RECORD' OF INSPECTIONS
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