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POSTED ON KROLL MAP NO.: PERMIT
UILDING DEPARTMENT ApplIcant FlII NUMBER
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
JAUE (Olt ft--- ) 0 ,b �-17
T�n ; a to . ! ' O � SIDE YARD SETBACK I STRE B I'BACK
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GAS
RESIDENTIAL ❑ LINE
❑ NEW NON-RESIDENTIAL
SIGN
ADD RETAINING
DEMOLISH WALL
ALTER EXCAVAT
E
OR FILL ❑ FENC.x.......... Ft.)
REPAIR PRE -MOVE SWIM
F` INSP. I ` POOL
DWELLING
UNITS
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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-
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
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.) ; j %
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
FIRE ZONE
❑ YES ❑ NO
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
710224
YES ❑ NO
DEFICIENCY THIS PROPERTY
❑ YES ❑ NO
Valuation I Fee
No.
TOTAL AMOUNT DUE
C�
ATTENTION APPLICATION APPROVAL
TINS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
A NI DATFJO SIGNE2A INSPECTION
DEPARTMENT
CITY OF
EDMONDS
GTE: Applicant Subjec toiflan Check Fee
PR a-1I07
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivewgs,
nmrquees, etc.) will require separate permission.
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APPLICATIQ • I & WORK PERMIT
). Application No.
CITY OF EDMONDS Building Department Permit Limit, One Year
APPLICATION is hereby made for a permit to construct the following work, in accordance with the accompanying plans
and specifications:
WORK —New/Addn. Ground Area .................................... No. Stories...1......
Plans Submitted ........................................................................... Const. Type....:........... Height .......
1
LOCATION — Ad ss .......Y ......... ........ ........................� � .W.........'�•.•............... Use Zone....'.4.:..;6.. Fire Zone ....................
s �
.................... Sewerage
p / '
Recorded Lot..?
oc...............""hd�'n............................... ............. ag I
f•c . Lot Area...» ................................... Width.13:..1': Ig:�..... Min. Bldg. Setbacks, Front and Rear...�.........�...... Sides...
r
.... ..... Address... Phone a
Owner. .......
Plansby.. !..f/............ ......... .......... Address........................................................................ Phone.........................
���C � v" �(' ... Address....
Bldg. by .. ................. ............. .......................... ................. ( � � � .
i
Plbg. by............................... ............................... ........................... Address ........................................................................ Phone.............. .........:
Heatingby........................................................................................ Address............................-..................................... Phone.............. ......_.. .. {
Elect.by ........................... .... _.............................................. 6........... Address ........................................................................ Phone ................................ l
Remarks............. ................ .................................................................................._......................................
..................................................................................................................................................................................................... ....... ..... ; .
.....................................................................................................................................................................................................................I.......................
..... -.......................... .....»........ ........... ................. ... ........................ ..... ........... ....................................... ...... .... ........ ..... ............ ... ...... .... ...... .. ... ......... ... ...............
,
3 1
The above is a correct statement and I agree to comply with all applicable Codes and State Laws regulating the work.
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the approved plans
and specifications and Building Department notations thereon.
VALUATION PERMIT FEES
moo? voo�
$...- .......,..................... � Bldg..... $..............7,�....,5.:'�..
APPROVED: gg
Date......... 1....r....................................
BUILDING DEPARTMENT
R� ft.., Herbert.,, Bldg. Insp
---- - .... ..
Plbg. .... $ ..............IX ..G2'�1:..
Heat .... $............... 3-..2-0.....
Elect. ....$........................................
Others...
$........................................
TOTAL
FEE
$.........1.... :.�......
NOTES: No work requiring Building Deparguent or City Engineer's inspection shall be covered before inspection and approval. 1 j
Twenty-four (24) hour notice requested. Contact the City Engineer prior to construction of all site utilities, such as 4 1
curbs, paving, driveways, sewer, water and street connections.
1
LE 1L DE�3GR {OT SON F6A ` LEO N KEPL'-ER h
r W.M. DESCR IIlLd
AZL THAT RORIIOw Oi' 6iOV LOT 6, Sict. 32' T.27N , R.:aE
A S' rOLLOMs
p.
BEGINNING',A.T THe:INTERSECtIQN OF LAKE DALLINGER SNORE LINE AND
THE NORT�t.'l,l?�A:-QF MGA'4EERWAY�. AS' SNQMl�1; ON PLAIT oF,;LAKE: $ALLINGER'
A i$ IVI �6N,;iyQ+ J,. AND-RECbRDEO ,IN :YOL. 9,.`: PAGE" 5T-58p RECORQS u
..
4F"SIIONOi!t1.SH ::COUNTY�'WA>iltrllOTONi :TNEN¢£ N 1°39'28aE.' ,ALONG `SA`10 SHOR[
LltIK T5 FtCT 'TO':{TNC TRUE POINT OF @EOINNING�'`4HENCE. N,..BB°20� 2"W,
f E[T� 7NENGE N _SRi•�,*6SW ;` • BEET ,TO; TNC, EASTE,RL,Y NE OF BRAD
LEY-
THENCE N' 13*04-:1.7 WV,:ALOW3 -THC. EASTERLY VIME�OF BRAOLEY ROAD .0;.,0
fE TO`;'TNE SOUTHEAST: CORNER TA�1CsT bF .LANO,CQNVEYEO ,TQ. AHNA M. , IrI1 NE3:
titB 1TOR's. F�1tE No-`-735950j ,THEbcE 5 '8d420t32" ,E,: ALONa THE SOUTH
L1(fE OFA.AQYE .DEB�piS.ED AMNA M«s �NES`rTRACTj 22S:96 FEET; THENCE .�
r $ :j �390 ZB"W�A�QNO Ai ORt SA-1'D SHO,R L 1 NE 100 .f.EET ;TO THE ; P01 NT . Of
�EiilNDfING'y TOGETHER 'MI{Tt{ SNORE LAND$' OF THE _,$ECOHO'-CL-A8W AS CONVE.,
BV THE 'STATE OF, WASH I NOTON S 1 Tt1AT[',f i_N' f RON.T OF � AD'JAC`ENT TO OR ,
ABtf1TING:YHE,REON� S1.TeiATE ;IN SN*HOMISN•:000NTY� WASNINGTON
RECORD OF INSPECTIONS
Date Passed
Foundation
i
Plumbing (Partial)
_ (Rough)
Frame
Furnace & Fuel Lines___
Final
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