710193.pdfBUILDING DEPARTMENT I AppltcantFIR
PERMIT APPLICATION Inside Heavy Lines
NAME (OR 111*16�
N orra���eo� _
MA ADDRESS
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O CITY � / • ✓Y T/ "\ (oN_
NAIA
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ADDRESS
CITY TELEPHONE NUMBER
NAME
DRESS
6 AD 9��
CIT7� TELEPHONE NU
or
NEW
RESIDENTIAL
LINE
ADD
I
El
NON-RESIDENTIAL
❑
SIGN
❑
wAiy NINE
DEMOLISH
E
FENCE
ALTER
❑
ORCFILL
❑
z_Ft.)
REPAIR
❑
PRE -MOVE
INSP.
El
........
svnm
POOL
?UMBER OF STORIES
NUMBER OF
J
DWELLING
/
UNITS
ID ON KROLL MAP NO.: f PERMIT I 0 193
NUMBER
3DRIMS Q W
��
YARD IIACK STREET SETBACK REAR YARD BET
YES 0 NO
EXISTING STREET R/W .YI.�^FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ... .FT. ... FT.
REMARKS
Driveway slopes not to exceed thoseiidicated
on Standard Drawing #1030
FIRE ZONlro I TYPE OF STRUCTION ( YSTREET IMO
C3NO
SPECIAL INSPECTOR REQUIRED I OCCUPANCY. ORO P /
YES O
PLAN CHECKED BY
REMARKS
l Tc� �0 6QD K(o0
Plan Check No .....................
BUILDING
PLUMBING
'r
N
ISWIMMING
HEAT h GAS LINE
FENCE
SIGN
RETAINING WALL
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that the In-
formation given In 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 parson
will be employed In violation of the Labor Cods of the Slate of Washington THIS PERMIT
relating to Workman's Compensation Insurance. AUTHORIZES
ONLY NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
liO1`7A'�-R O GENT E SIGNEi� INSPECTION
77 /VAS � �r/J � DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR M1107
This Permit coven work to be done on Private Property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) win require separate permission.
Valuation
1
Fee
v
No.
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 F
1, '
, }
Date Passed
47
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_.. _ Foundation /
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,
Plumbing (Partial)
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;
(Rough) 'H ,
_ Frame T-a7
! Furnace &Fuel Lines_ Z—�� %� at
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RECORD OF INSPECTIONS i
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Y Parking',
Landscaping
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