710289.pdf,
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POSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant Fill I N"IIB�' 710289
PERMIT APPLIInside Heavy
CATION Lines JOB ADDRESS
NAME
SETBACK } STREET SETBACK REAR YARD SET
I
1965 3
W 1�
l TELEPHONE NUMBER
I CITY LICENSE NUMBS
ow or Attach Four Copies)
I
M
Al
RESIDENTIAL
❑
GAS
NEW
LINE
ADD
NON-RESIDENTIAL
❑
SIGN
❑
WAKING
LL
DEMOLISH
EXAVATE
ALTER
❑
OROFILL
❑
Ft.)
PRE -MOVE
(ENC.x..........
SWIM
REPAIR
INSP.
POOL
DWELLING
UNITS
t
I
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.
Iced agent of the owner. I agree to comply with city and statb laws regu.
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
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 eom.
pleted In six months.)
/1�5__
NOTE: Applicant SWbject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
6
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
❑ YES ❑ NO
DEFICIENCY THIS PROPERTY
❑ YES ❑ NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
❑ YES ❑ NO TI�IIS SITE IS LOCATED IN THE
PLAN CHECKED BY LATY OF EDMONDS. LOCAL SALE
TAX SHOULD BE CODED 31.04.
REMARKS 1
Cap satin :'ewer coo
COMC .
Valuation
Plan Check No .....................
No.
,
,
BUILDING
PLUMBING
HEAT d: GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION "� �O
PRE -MOVE INSPECTION ��
EXCAVATION OR FILL 1
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
'This application is not a permit lentil
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.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR g-1107
FILE
INE
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RECORD.OF. INSPECTIONS
Date Passed .
l A
,-.. ;.Foundation
{'
1 , }:
_ ,Plumbing. (Partial) ------
- (Rough)
Frame "
- .,Furnace &Fuel Lines
_ _ , __ Final
Ire
-
RECORD -0F INSPECTIONS
j Date' Passed:'
t Drainage ---------
Sewer --11
—
I Parking
Landscaping -----
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Fire Dept.
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