710435.pdfI
BUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF II Ed8)
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Applicant Fill
Inside Heavy Lined
Ace Ail
ELEPHONE NUMB
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CA m covNAGA
STED ON KROLL MAP NO.: I PERNUMMIT 710435
IADDRESS
❑ YES ❑ NO
EXISTING I STREET R/W ... QJFT• DEFICIENCY THIS PROPERTY
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COMP. PLAN.......... •
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REMARKS Driveway slopes not to
indicated on Standard Drawing
exceed those
#103.
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or
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TYPE
BY
B .— /ti') + �• -JI IV ❑ YES No i
!/ 6 SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
GAS
RESIDENTIAL a LINE ❑PLANECHECKEDBYO
NEW THIS SITE
NON-RESIDENTIAL ❑ SIGN CITY OF EDMONDS, LOCAL SALE
ADD ❑ RETAINING REMARKS TAX SHOULD BE WULLI
❑ DEMOLISH WAIT' 1
❑ ALTER ❑ EXCAVATE FENCE
OR FILL (.......... x.......... Ft.
swim
❑ REPAIR ❑ PRE-INSP. ❑ POOL
NUMBER OF STORIES NUMBER OF
/ *Qdt } DWELLING
414seAlle w- I UNITS ,
NATURE OF WORK TO BE DONE J►. �/ Valuation Fee Receipt No.
co ^45-fxy G/ N � Plan Check No .....................
Reside NC @. BUILDING _ �—
PROPOSED USE PLUMBING
,ne-
PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT & GAS LINE
O ore C- A- �� („^� FENCE 1
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SIGN
RETAINING WALL I i
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SWIMMING POOL
DEMOLITION '
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PRE -MOVE INSPECTION 4
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! EXCAVATION OR FILL
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TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-' '
formation given to 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- ATTENTION APPLICATION APPROVAL
lating construction; and In doing the work authorized therbby, no person
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT This application is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep- -
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ae-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com- knowledged in space provided.
pleted In six months.)
I
81 ATURE ( YNER OR AGENT DATE 8I5NED INSPECTION DIRE R. S NATU '
/� y �— w/_�/ DEPARTMENT '
/6 CITY OF DwT '
EDMONDS
NOTE: Applicant Subject to Plan Check Fee — 7/ . •. �`
PR 0-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, FILE '
marquees, etc.) win require separate permission.
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(Rough)
Frame
Furnace & Fuel Lines
Final
4
RECORD
OF INSPECTIONS
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Date.Passed—
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Drainage
Sewer,
Parking.
Landscaping
Fire Dept.
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