710179.pdfr
[1RI
BUILDING DEPARTMENT
PERMIT APPLICATION
Applicant Fill
Inside Heavy Lines
�-
I H — S o A(U
TELEPHONE NUMB
ONDS I P90_198b
„01
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
or
RT 32A 5 355' d E /93'o/ E- z
W
SE " s ' /ess Ego/
4
/ass 5 306&97 '
PERMIT 7
NUMBER 10179
AyE'-
1ACK I REAR YARD SETB)
IVACANT BITE
❑ YES ❑ NO
DEFICIENCY THIS PROPERTY
CW,
F
a_ FIRE ZONE (TYPE OF CONSTRUCTION STREET IMPROVED
❑ YES ❑ NO
SPECIAL INSPECTOR REQUIRED (OCCUPANCY GROUP
GAS ❑ YES ❑ NO
to RESIDENTIAL � LINE PLAN CHECKED BY
NEW ❑ NON-RESIDENTIAL ❑ SIGN
ElADDEMARKS
R y RETAINING It��� ��
�l'_(11I DEMOLISH� WAIT'
ElALTER EXCAVATE FENCE
OR FILL (.......... .......... Ft.) {% �` j�,( 1, WV
n , �r''� /� �j
REPAIR ❑ INSP. MOVE SWIM POOL F—C `NCE aLC, � C VIU S FRO H vrr� •
NUMBER �F BTORiE9 I NUMBER OF
DWELLING /
UNITS
NATURE OF WORK TOBEBE DONE ]mil I Valuation I Fee Rceclpt No.
kE 4 0 VA ` 0 tr 8 U eN e-D 14_005LL Plan Check No .....................
BUILDING
[py�
of PROPOSED USE
�y
PLUMBING
U
aPLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
O
FENCE
SIGN
tRETAINING
WALL
N
I
SWIMMING 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 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 State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
be completed In Nnety days; MOVED -IN BUILDINGS shall be com-
d In six months.)
L�shallTE:
ATURE (OWNER Olt AG NT) DATE SIGNED
INSPECTION
_
DEPARTMENT
�
`�
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR a-Iloi
This Permit covers work to be dune on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
t V 0
06 I (00213
. 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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RECORD OF INSPECTIONS
Date Passed
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