710491.pdfC.
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ON KROLL YAP NO.:
B,UILDIND
DEPARTMENT
Applicant F1:81DE
PERMIT
APPLICATION
Inside Heavy
RESS —
1
(OR NAME OF BUSINESS)
ETBACK STRE
�
NE
LOT+
4TELEPHONE
NUMB
I �/
� nrrn:
()'\ O i( (`
or
NEW
MV
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
❑ ADD
SIGN
ALL NINE
❑
DEMOLISH
❑
W
I A I ALTER
E
FENCE
Y❑"'
❑
OR FILL
(......... z.......... Ft. )
REPAIR
❑
INSP.
BWIL
iUMHER OF BTORIE$
NUMBER OF
DWELLING
I
UNITS
PERMIT
NUMBER
IT SETBACK
C�s
710491
MAR YARD BETE
.CANT SITE
YEB )d NO
LISTING STREET R/W ... ........ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ......... ».FT.
S
C NB�TRC;I
r A/
❑ YES 5 NO
❑ YES ❑ NO
THIS SITE IS LOCATED IN THE
REMARKS CITY Or LUNIUNUJ. LOM SAtEt
TAX SHOULD BE CODED 31.04..
Plan Check No .....................
BUILDING
PLUMBING
tRETAINING
N
ISWIMMING
HEAT & GAS LINE
FENCE
SIGN
WALL
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
In-
I hereby acknowledge that I have read thin application;jbecom-
formation given is correct; and that I am the owner, or the hor-
ised agent of the owner. I agree to comply with city and statregu-
ATTENTION
IaUng construction; and In doing the work authorized therebrson
lating
will be employed In violation of the Labor Code of the State ogton
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Your (Except DEMOLIThich
ONLY
WORN: NOTED
shall be completed In ninety days; MOVED -IN BUII.DINGS scom-
pleted In six months.)
pleted
)ION/jR AGENT)
DATE
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR a -Mint
This Permit covers work to be done on private property ONLY.
Any construction on the pubUo domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
No.
0
M-0
O
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
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s,'.. ' D'3jr }. RECORD OF' INSPECTIONS , ,
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Date Passed '
1
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I Plumbing (Partial) I/ 1 ,r�
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t; Furnace &Fuel Lines j .' T t .
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t RECORD OF INSPECTIONS c € .1.
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Date Passed
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;' I Drainage u_ ,I
r I , `Sewer M1' ' r ,f ` +' n% I
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'� Parking _ I . II
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