710403.pdf_. _._
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BUILDING DEPARTMENT AppilcantFill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINN III
1, ), / i�Dr1) -SR.
•
tz, a3--o)-R5
Legal Description of Property (Sti
W
11d
I
or
NEW
RESIDENTIAL
GAS
LINE
1
NON-RESIDENTIAL
❑
SIGN
El ADD
ElDEMOLISH
DEMOLISH
WALL
PENCE
ALTER
❑
ORCFILLTE
El
x.......... Ft.)
wim
REPAIR
❑
I SP.
p OL
(UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
C
MAP NO.: PERMIT
NUMBER
'710403
Svor v• w
3IDE YARD SETBACK(
STREET SETBACK
REAR YARD SETBACK
I
v
i
i
USE
LOT AREA
VACANT SITE
ZONE ']
❑ YES 0 NO
! ..
HEIGHT
AREA
NUMBER
(BUILDING
(VARIANCE
I i
) %
,
PLOT PLAN APPROVED
0 1
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
n
'
FIRE ZONE I TYPE OF CONSTRUCTION
YES NO
_7S-T u
Plan Check No .....................
`
BUILDING
PLUMBING
Iding setbacks, abutting streets)
N
ISWIMMING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
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 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 lawn regu-
ATNTION
TE
lating construction; and In doing tho 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
N Per 1i i4 One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
all b com'I ed Inn sty days; MOVED -IN BUILDINGS shall be com-
letcd n six onths.)
'MIGIOLTUMEWWNFA OR AGENT)
DATE SIGNED
INSPECTION
/X
DEPARTMENT
CITY OF
EDIIIONDS
NOTE: Applicant Subject to Plan Check Fee
PR 8-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
YES NO
CITY OF EDMONDS. LOCAL'S
COD 31
Valuation
Fee
a
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.
DATE
FILE
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RECORD OF INSPECTIONS
Date Passed
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Plum
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(Partial) —
ough)
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_ Furnace & Fuel Lines-;--- J �y
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__. _..... _.,_..... ... ...RECORD OF INSPECTIONS
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Date
Passed
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