710599.pdfa
s
BUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Linea
,71 PL.,
TELE
EBB
TELEPHONE NUMBER
E
:Ctscac4ca Co V1.s-T.
RESS �I
01
vlYo'-a /U .
�TELEPHONE NUMBER
Me a-�f_360
CE LICENSE NUMBER CITY LICENSE NUMBER
a3-nl-'6&,+
11 Description of Properly (Show Below or Attach Four Copies)
�NO.: PERMIT _
NUMBER
S7e?-ri�e
fARD SETBACK STREET SETBACK REAR YARD BETS
�_
:ONE I LOT AREA I VACANT SITE
f 13 YES '� NO
PLOT PyAN APPROV
- jde y4v
`
STREET R/{
EXISTING STREET R/W
COMP. PLAN ST. R/W
............FT. -,' DEFICIENCY THIS PROPERTY
...........FT. - ........FT.
REMARKS
-
CHECKED BY
METER SIZE I SERVICE SIZE I LEARANCE
I CHECKED BY
REMARKS
TYPE CONNECTION
(VERIFIED BY
PERC. TEST
PERMIT NUMBER
0
Zz
i�
Ke c
kZ
'REMARKS
C —,
FI Z
I TYPE OF C TI UCTIQN TREETIMPROVED
SS NO
{I�OJCCUPANCY
SPECIAL INSPECTOR REQUIRED
0 YES .,/yam NO
GROUP
I
❑ NEW.
Ixl ADD
i"
ALTER
ElREPAIR
❑
❑
n
RESIDENTIAL
NON-RESIDENTIAL
DEMOLISH
EXCAVATE
OR FILL
INSP.PRE-
El
❑
❑
�
GAS
LINE
SIGN
RETAINING
WALL
FENCE
(.......... x.......... Ft.)
POOL
PLAN CHECKED
DY
THIS SIT r n —
REMARKS
-�" rIN I HE
CITY C1r-^; 'i'"'•.^ r - 1
TAY r. ;-. ,. •,. `I_�r-.S
ALL
.2...ii/7.�
A)swimD' Pd • — [ /
DWELLING
UNITS
e C
t
N
I
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 stale 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.)
Plan Check No .....................
BUILDING
PLUMBING
HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
BP7IMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
Valuation
.Z2 Ste.
Fee Receipt No,
1 1 .�. ✓• r a.� r r ..
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
TILE
WORK NOTED
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
tATURE (OWNER OR AGENT) DATE SIGNED INSPECTION
DEPARTMENT
/ CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fe
PR a-uoa
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) win require separate permleslon.
FILE
1
1
N
s
-_
�'
1