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BUILDING DEPARTMENT]Inside
ApplicantFiU
PERMIT APPLICATION Heavy Lines
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RESIDENTIAL
❑
GAS
LINE
® NEW
❑
NON-RESIDENTIAL
❑
SIGN
ADD
❑
DEMOLISH
a
RETAINING
ALTER
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EXCAVATE
ORFILL
❑
FENCE
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REPAIR
❑
INSP.
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WIM
POOL
YUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
zI
y PROPOSED USE
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aPLOT PLAN (Indicate Bullding setbacks, abuttln
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N
^w
)N KROLL MAP NO.: PERMIT
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I NUMBER
IESS
'7 :2
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P `R,
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RD BETB CK
STREETS K
Berk
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Rana. z....., SETBACK
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I a5
NE
LOT AREA
VACANT SITE
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YES ❑ NO
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Z
, VARIANCE NUMBER
STREET R/W �A
EXISTING STREET R/Wi[MSSFT. DEFICIENCY THIS PROPERTY
COMP PLAN ST n/w O- SFr 6••" '
REMARKaDriveway slopes not to exceed those
indicated on _Standard Drawinc,
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 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.)
. S%Jo
VIPCT4.4 to-ti
%j I ❑ YES [] NO
SPECIAL INSPECTOR REQUIRED• IOCCUYT E
T
❑ YES X_NO V _ 17,
PLAN CHECKS BY '('HIS SITE IS LQ(-'• '`—
REMARKS :FAX SHOULD GE CO7"L) 311041
Plan Check NO .....................
BUILDING
PLUMBING
HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
W1041 -A
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Fee
p
8/-aef
TOTAL AMOUNT DUE
ATTENTION APPLICATION APPROVAL
TRIs PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
THE
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in apace provided.
INSPECTION DIRECTOR'S IONAT
DEPARTMENT
CITY OF DATE
EDMONDS ,
r
PR 6-1107
FILE
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(Rough) �-
Frame
Furnace & Fuel Lines—f
Final
RECORD OF INSPECTIONS
i
Date
Drainage f�
Sewer -
Parking "ter
Landscaping
Fire Dept.
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