710405.pdfr'r
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BUILDING DEPARTMENT
PERMIT APPLICATION
1 NAME MR NAMF. nF nPRINEHH/
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Below or
Applicant Fill
Inside Heavy Lines
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PERMIT
B A')URES$
SIDE YARD SETBACKI
STREET SETBACK I
REAR YARD SETBACK
USE ONE SIN
LOT AREA
I VACANT SITE
YES 13 NO
HEIGHT
I BUILDING AREA
I VARIANCE NUMBER
11L x FLAN ArrKUvXU
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT..
REMARKS
Ej YES 0 NO
RESIDENTIAL
❑
GAB
LINE
YES NO
NEW
PLAN CHECKED BY
THIS SITE IS LOCATED IN
H
NON-RESIDENTIAL
❑
SIGN
CITY OF EDMONDS. LOCALS
S
El
ADD
❑ DEMOLISH
RETAINING
WALL
REMARKS
TAX SHOULD BE CODED 31
❑ALTER
EXCAVATE
FENCE
�!
�
❑ OR FILL
(xFt.)
REPAIR ❑
INSP.
.......... ..........
wim
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POOL
(UMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
1ATURE OF WORK TO BE DONE
_ Valuation I
Fee I
Receipt No.
H
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING WALL
N
ISWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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.
kiting 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.)
NOTE: Applica object to Plan Cbeck Fee
This Permit covers work to be done on private properly ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
ATTENTION
TINS PERMIT
AUTHORIZES
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
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.
FILE
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- RECORD OF INSPECTIONS
_ Date Passed
Foundation
Plumbing (Partial)
(Rough) / _ 3 73
Frame
Furnace & Fuel Lines
Final
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i RECORD OF INSPECTIONS ..,._ _..,.__ m
Date Passed
,
'Drainage PL
Sewer
Parking ------' P;t3
Landscaping, at
Fire Dept.
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