710220.pdf1 ' • 1
1 POSTED ON KRC
BUILDING DEPARTMENT Applicant Fill A,
PERMIT APPLICATION Inside Heavy Lines JOB AMDQREBS
NAME (O.
8ID E YARD BE7
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6
F
x
._ 19v-1/1 K to 1
ADDRESS
or
;G
RESIDENTIAL
GAS
LINE
NEW
❑NON-RESIDENTIAL
❑
SIGN
❑
ADD
❑
RETAINING
WALL
DEMOLISH
ALTER
❑
ORFILL
❑
FENCE
(.x..........Ft.)
REPAIR
❑
IN P;1fOVE
Pwim
OOL
DUMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
NATURE OF WDRK
TO f3E.YTE
EXISTING STREET
HAP NO.:
(�
x
a..5-1
LOT ARE/
IZ,&
PERMIT
NUMBER
BACK RE
710220
t YARU BETBACIC
,NT SITE
IS ❑ NO
DEFICIENCY THIS PROPERTY
.1..FT.
on Standard Drawing #103.
3
UPC ` Al3Cr 16 —Z
70NNECTION VERIFIED BY
sew �- I -
TEST I PERMIT NUIMBER
OF
❑ YES
/ V I ❑ YES
S061-11 " 4r-W 1 j6C-rJ A$- IAE;:�/OiV HM
Cj/ZP67r- IrizcJSSLs
Plan Check No .............
BUILDING
PLUMBING
HEAT & GAB LINE
FENCE
SIGN
RETAINING WALL
SWIMMING 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 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 Stale of Washington THIS PER511T
relating to Workmen's Compensation Insurance, AUTHORIZES
ONLY THE
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.)
IIGNATURE (OWNER OR AGENT) DATE SIGNED INSPECTION
DEPARTMENT
iI !7• �L�/ CITY OF
EDMONDS
NOTE: Applicant Subject to Plats Check Fee
PR 8-1107
Thin Permit covers work to be done on private property ONLY.
Any construction on the publle domain (curbs, sldewalhs, driveways,
marquees, etc.) will require separate permission.
Valuation
1 V 0
Fee
APPLICATION APPROVAL
I
m
L
Tilts 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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SPECTIONS
...RECORD OF'IfI� .. I ,.�.
Date Passed4 IT
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Foundation I 1 ;
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,
Plum ing ( I)
4.(Rough) —23 7(
Frame .fy
_ Furnace R: Fuel Lines
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Final
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RECORD"OF INSPECTIONS
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Drainage , . ,,
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Sewer
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