710176.pdfPOSTED ON KROLL MAP NO.: PERMIT
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710176
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G DEPARTMENT
Applicant Fill
I NUMBER
!APPLICATION
Inside Heavy Linos
JOB ADDRESS
1�if�@
(/ �.SIDEYARD
F-NAME(OR
SETBACK
STR ET SETBACK
REAR YARD SETBACK
R Bs
4�1
Cj Cj
USE ZONE
LOT AREA
VACANT SIT,TEyLEi
PHONE NUMBER
❑ YES ❑ NO�'
11 A I
• j j7 q ^ ZQ f /
HEIGHT
I BUILDING AREA -
I VARIANCE NUMBER
7r
C
c
NEWI
RESIDENTIAL
n
GAS
LINE
NON-RESIDENTIAL
❑
SIGN
ADD
RETAINING
El
❑
WAT�AINING
EXAVATEl
CFILL E
ALTER
ORC
❑
`ENC x
Ft.)
REPAIR
❑
PRE -MOVE
INSP.❑
..........
swim
POOL
DUMBER OF STORIES I NUMBER OF
DWELLING
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT. t7
REMARKS
F
3
FIRE ZONE OF CONSTRUCTION
STREET IMPROVED
(TYPE
❑ YES ❑ NO
SPECIAL INSPECTOR REQUIRED
GROUP
❑ YES ❑ NO
(OCCUPANCY
PLAN CHECKED BY
R ARKS
b It
1 0
Valuation
Fee
Receipt No.
Plan Check No .....................
L
\� tLS
BUILDING
U
PROPOSED USE
PLUMBING
aPLOT
C
n
PLAN (Indicate Building setbacks, abutting streets)
tRETAINING
N
ISWIMMING
HEAT d: GAS LINE
FENCE
SIGN
WALL
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 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-
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
TIUS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be sproPleted In ninety days; MOVED -IN BUILDINGS shall be com-
pleted XsIx month
;ION URF. (ON)(ON)M31t OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
— _
CITY OF
EDMONDS ,
NOTE: Applicant Subject to Plan Check Fee
PR 8-1107
This Permit covers work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, drlvewgs,
marquees, etc.) will require separate permission.
o.l {!c o1
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
loy; and fees are paid, and receipt is ac-
knowledged in space provided.
D OR'S SIONAT 1111E//
DAT
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' RECORD OF INSPECTIONS _. '.. f
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�Date Passed
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_ Foundation
_... _. _.... ... _. on
i i lumb'ng (Partial) i /'
- 2Y 11 '/"� "t
5 ' (Rough) •;,
! _ ' Frame
i -9 Furnace & Fuel Lines
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I RECORD OF INSPECTIONS
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Date Passed
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i Sewer
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Landscaping si
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Fire Dept. 9 SO
Or 9
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