710192.pdfr
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BUILDING DEPARTMENT I Applicant Fill
.PERMIT APPLICATION Inside Heavy Lines
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NAME
MAILING ADDRESS
906oT- 5., ; ate.! h----
CITY TELM
i�PmA-f '/y I ae(
NAME
JQ.�AM�,L�ti
,� Ni V �- / • foe
TELEFE
or
mf-
kRD SETS
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NE NUMBER EXISTING STREET R/W
COMP. PLAN ST. R/W
REMARKS
Drivewav slope
His
on Standard Di
[ARKS 0 1
Ve
E CONNECTION
5t: wU4,
NO. • PERMIT
NUMBER
n
X.e
WREMARKS
O
UPS- l two
(� FIRE 91 I TYPE OFJ
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RESIDENTIAL
GAS
LINE
0 YES
1 YI NEW
PLAN
'7`❑�'
❑
NON-RESIDENTIAL
❑
SIGN
ADD
❑
DEMOLISH
❑
WANINE
REMAI
ALTER
❑
EXCAVATE CFILATE
❑
PENCE
Ft.)
...x..........
REPAIR
❑
PRE -MOVE
INSP.
El
swim
POOL
iUMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
Plan Check No............_.......
O
BUILDING
?g�
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PROPOSED USE
PLUMBING
HEAT k GAS LINE
Q PLOT PLAN (Indicate Building setbacks, abutting streets)
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n
N
1
FENCE
SIGN
RETAINING WALL
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 in correct; and that I am the owner, or the duly author -
teed agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
lating construction; and In doing the work authorised thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to WorkmeWs Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITION8 which
ONLY T
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
1I NA T (OWNER OR A6 T) DATE SON D
INSPECTION
DEPARTMENT
S r 7
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curb@, sidewalks, driveways,
marquees, etc.) will require separate permission.
I P
not to
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A
710192
i] YES ❑ NO
DEFICIENCY THIS PROPERTY
YES
UP
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Fee
S-6
[] NO
I' ele71. s_bI boa y
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.
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RECORD OF.INSPECTIONS "4
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IN
Date Passed
:Foundation
_ ;Plumbing (Partial)
(Rough)
r:-
,Frame
e Fuel
�. Furnace & I Lines—
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Fin
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RECORD'OF'INSPECTIONS SI n rt
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Date Passed +� aYi tt{3.�°1F
+ s 1 At �:, P,N k i• , \ t Il9. f L; f Ie L1 `�� r•X u, z+•.�'33l 4'� t.,
Drainage a { ( t • ai 'a t3'7.t1 :y S.
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, 1 2 1 +s -Sewer r ,1----;,—�. —�'. rl • rtE�'�`f X;..a3v°�r`}h�r
rt , .. , :•a s. 't Clf fiikly 45
Parking
Landscaping I 9
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Fire Dept.
411,K i zF;
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