710538.pdf'/t
Legal Description
O
W�
.7
NEW
ADD
ALTER
REPAIR
T-
M
C�
or
Applicant Fill
Inside Heavy Linea
uRESIDENTIAL
^
1 1 NON-RESIDENTIAL
DEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
INSP.
DWELLING
UNITS
NE t
ElOAS
LINE
SIGN
RETAINING
WALL
FENCE
(....... _....... Ft' )
Ffswim
` POOL
rL
r
; ' c
ISTED ON KRPERMIT OLL IG\P NO.: I O.7v'C�
I NUMBER
B ADDRESS - O
;C
DE YAA BETHAC B BE AC REAR YARD BETBACI( ,
).
O
I E ZONE LOT AREA VAOANT BITE
A / I ❑ YES ❑ NO
ETMT BUILDING AREA VARIANCE NUMHEft'
I I r
LOT PLAN APPROVED l
,
rREET B/W
IXISTING STREET R/W ......_.... FT. DEFICIENCY THIS PROPERTY 1
COMP PLAN BT R/W .FT. ............FT. p,,,
tEMARKB •
v
r.
CHECKED BY
SETER SIZE I SERVICE SIZE I CLEARANCE I CHECKED BY
.1
REMARKS
4
TYPE CONNECTION I VERIFIED BY
I
PERC, TEST I PERMIT NUMBER
j$�j7 �•.,
REMARKS
.I'
FIRE ZONE I TYPE OF CONSTRUCTION STREET IMPROVED 1
1.
❑YES ❑NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
❑ YES ❑ No Irr Ic I OCATED IN TNF '
PLAN CHECKED BY
CITY OF EDMOI`IDS, LOCAL SALES
ftEMARKB .AX SHnl li n j2cp COIIFL131 0A
Plan Check No, ... _...............
BUILDING
PLUMBING
HEAT A CAB LINE
FENCE
BION
RETAINING WALL
N
I SWIMMING 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-
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Slate of Washington
relating to Workmen's Compensation Insurance. -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUUMINOB shall be com-
pleted In six months.) _
-�� //971
NOTE: Applicant Su lect to Plan Check Fee
Tile Permlt coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways@
muquees, etc.) win require separate permiselon.
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
Valuation
3 Ss�
i
APPLICATION APPROVAL l
This application 1B not a permit until
signed by the Building Official or his Dep- j
uty; and fees are paid, and receipt is ac-
Imowledged in space provided. 1
DIRECTOR'S ION
DATE
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