710312.pdfBUILDING DEPARTMENT Applicant Fill
_ PERMIT APPLICATION Inside Heavy Lines
NAME ( )
ILING ADDRESS
leYe l 7I -ice � zU ,.
CITY , I TELEPHONE��Z NUMBER -7
13/1
WADDRESS
7 CITY TELEPHONE NUMBER
NAME
1?17 "/f'.
W ADDRE88
P a 13OX �f22-
.
CITY TELEPHONE NUMBER
3 3 3 v
STATE LICENSE NUMBER CITY LICENSE NUMBE
Description of Property (Show Below or Attach Four Copies)
O I1W/-y/J G 7- rP cP 7-4 L-/9, 2 T P 1
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NO.: PERMIT
NUMBE,�RC
BIDE YARD SETBACK
STREET SETBACK
REAR YARD SETBACK
USE ZrONE
LOT AREA
VACANT SITE
e- _4. C)
I
I IYYES 17 NO
HEIGHT
BUILDING AREA
VARIANCE NUMBER
Vr/
Y1- r CLAN AYYKUVri1J
EXISTING STREET R/W .`` J-0-FT. DEFICIENCY S PROPERTY .:
COMP. PLAN ST. RIW .6D..XV. .....FT.
REMARKS
Driveway Slopes not to exceed those
indicated on Standard Drawing #103. z
'514
IKS
CoOe ; C 1
�(� aka
CONNECTION (xD I VERIFIED BY
s- e-W er 11,4- ` fl-&
W REMARKS
A
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.i FiRE Z I TYPE�NSTRUC.TION STREET IMPROVED
//t1VV11 I 0 YES [3 NO
SPECIAL INSPECTOR REQUIRED OCUUFANCY-GROAJP
® RESIDENTIAL GAS ❑ YES NO I I
NEW ❑ LINE PLAN CHECKED BY
® ISMS LOCATED IN TF
❑ NON-RESIDENTIAL ❑ SIGN /� • CITY OF EDMONDS. LOCH SAI
❑ ADD RETAINING REMARKS
❑ DEMOLISH ❑ WALL r-+ TAX SSHOULL�BCOD ED 31.0
❑ ALTER '®1,��J1' EXCAVATE ❑ FEN � N • �' �bU N 1 l `m �T
OR FILL..z.......... Ft.)
u ❑ PRE -MOVE SWIM �� `�•"' REPAIR u INSP. ❑ POOL
NUMBER OF STORIES I NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
,U/ U/ n �� / Valuntion I Fee Recelpt )
N
. I
I hereby acknowledge that I have read this application; that the 1n.
[�nhall
mation given In correct; and that I am the owner, or the duly author-
d agent of the owner. I agree to Comply with city and state laws regu.
ing construction; and In doing the work authorized thereby, no person
l be employed In violation of the Labor Code of the State of Washington
ating to Workmen's Compensation Insurance.
OTE: Permit Limit One Year (Except DEMOLITIONS which
be completed In ninety days; MOVED -IN BUILDINGS shall be com.
ted In six months.)
NA R (OWNER OR A T .� DATE s 771
,
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, eldewnlks, driveways,
marquees, etc.) will require separate permission.
Plan Check No ................
BUILDING
PLUMBING
HEAT k GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR g-1107
so:
I
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(CIS S
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.
DIRECTO,R!B SIGN
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;. �__.. RECORD OF INSPECTIONS !
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Date P ed
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Plumbing(Partial)
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Frameo
:,.: , 7 &Fuel Liries�� "? , _ ,
$ Furnace
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RECORD•OF INSPECTIONS ,7 a> ,4 "°`"'�`
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Date.Passed • sra;a
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Drainage
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Sewer ;
Parking rP ' r " �
7 Mary �r I
� Landscaping ',,fit �>
Fire Dept. ;.Of olg
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