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BUILDING
DEPARTMENT
PERMIT
APPLICATION
NAME (CH
K�ILINA�15 /7A�ViV
6 ADDRESB
/n.o _-� -
/fry
Applicant Fill
Inside Heavy Lines
DDRESS
8'a6 S'0• )3/f4qqe1"1t1i
LTY TELEPHONE NUMBER
or
NEW
RESIDENTIAL
u❑
LINE
ADD
NON-RESIDENTIAL
❑
SIGN
❑
DEMOLISH
a
WALL NING
EXAVATE
E
ALTER
❑
ORCFILL
ElFENCx
Ft.)
PRE-MOVEOINSP.
..........
SWIM
REPAIR
❑
POOL
iUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
4ZA.TURE OF WOR�II1VpO')
BE DONE
J
)STED ON KROLL MAP NO.: I PERMIT -
NUMBER
H ADDRESS
SIDE YARD SETBACKI
STREET SETBACK I
REAR YA
U,�E ZONE �c
LOT AREA
VACANT G
HEIGHT
I BUILDING AREA
I VARIANC.
PLOT PLAN APPROVED
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. RIW ............FT. ............I-
59
REMARKS v0_eue_
FIRE ZONE I TYPE OF CONSTRI
SPECIAL INSPECTOR REQUIRED
C] YES ❑ NO
PLAN CHECKED BY
REMARKS
Plan Check No .....................
BUILDING
PLUMBING
BEAT d: GAS LINE
FENCE
SIGN
I RETAINING WALL
N
ISWIMMING 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-
lzed 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 THIS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY TILE
NOTE Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
e6ypl be c mpleted In ninety days; MOVED -IN BUILDINGS shall be com-
feled In Ix months.)
16I�jAT RE (OWN lt; AGENT) DATE 816NED INSPECTION
I DEPARTMENT
1 �_ Tr� — `
1 6—
E: Applicant Subject to Plan Check Fee
This remit covers work to be done on private property ONLY,
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
CITY OF
EDMONDS
PR 0-1107
BY
[] YES i7 NO
THIS SITE IS LOCATED IN TH
ITY OF EDMONDS. LOCAL SAL
TAX SHOULD BE CODED 31.0,
Valuation
Fee
W
v
W
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
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'Plumbing (Partial)
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Furnace & Fuel Lines
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RECORD OF INS
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