710467.pdf✓i ' , _ POSTED ON KR_OLL MAP NO.: PERMIT --�
BUILDING DEPARTMENT NI)MBER 7'1046 r
nppueant Fill
PERMIT APPLICATION Inside Ileavy Lines JOB ADDRESS )
NAME (OR NAME OF BUSINESS) � � "`�`� ✓ t/�
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CITY -- -- - -- - I TELEPHONE -NUMBER -
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STATE LICENSE NUMBER - I CITY LICENSE
Legal Description of Property (Show Below. or Attach Four
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RESIDENTIAL
NEW �
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NON-RESIDENTIAL
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SIGN
RETAINING
❑ DEMOLISH
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REPAIR ❑ PRE-MOVE❑INSP.
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POOL
DWELLING
UNITS
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USE ZONE
- LOT AREA
VACANT SITE
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YES 0 NO
HEIGHT
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VARIANCE NUMBER,
PLOT PLAN APPROVED - -- -
7-6 %
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STREET R/W
EXISTINGSTREET R/W ............FT.
DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT.
.........FT. O
REMARKS
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(CHECKED BY
METER- SIZE- SERVICE SIZE
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CHECKED BY --
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REMARKS-
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TYPE CONNECTION - - -
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-VERIFIED BY - -- -
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PERO.-TEST -
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PERMIT NUMBER -
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REMARKS
FIRE ZONE-- - TYPE OF CONSTRUCTION - ' STREET IMPROVED
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SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP - ----
YES 0 NO
PLAN CHECKED BY
ng15 LOCATED IN THE
CITY OF EDMONDS. LOCAL SALE
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REMARKS
TAX SHUULU BE CODED 31.04.1
Ilan Check No.....
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Valuation
Fee
09
pt No.
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TOTAL AMOUNT DUE
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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 laws regu-
ATTENTION
APPLICATION APPROVAL
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1¢ting construction; and 1n doing the work authorized thereby, no Derson
will be employed In violation of the Labor Code of the State of Washington
TIIIB PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZER
Signed by the Building Official Or his Dep-
NOTE: Permit Limit One Year (Except DEIMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
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shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
knowledged in space provided.
pleted In six months.) '
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
D1REC R'8 SLG R ,
'
('ITY OF
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
PR 8-1107
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This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FILE
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marquees, etc.) will require separate permission.
RECORD OF INSPECTIONS
Date Passed
Drainage
Sewer
Parking
Landscaping
__ Fire Dept.