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BUILDING DEPARTMENT Applicant Fill USE {� � —/� NUMBER � 40092
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PERMIT APPLICATION InAldo Heavy Lines IDD
ADDRESS /
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NAME ( R NAME OF 81N�8B) r
PERMISSIBLE a ACTUAL
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PERMISSIBLE
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REQUIREd YAItDtl PROPOSED YARDS
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NAME / FRONT BIDE REAR FRONT SI E REAR
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ADDRESS LE6 LOT VARIANCE OR CON UITIONAL IIHE
N PERMIT NUMBER
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, DEFICIENCY THIS PROPERTY
DEMOLITION
EXIST STREET R/ ,l /1
NAME
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REMARKS
to those
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ADDS. SS Driveway slopes not exceed
n �oX /p �� indicated on Standard Dwg� Niall
CRECK Y
1 heresy acknowledge that I haus read this application; that the in.
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formation given Is correct; and that I and the owner, or the duly author-
CITY
TELEPH'O/NE ' 1
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lauag construction; and In doing the work authorized thereby, no person
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STATE LICENSE NUpMBpER
CITY CENSE NUMBER /
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AUTHORIZES
signed by the Building Official or his Dep -
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NOTE: Permit Limit One Year (Except DEMOLITIONS which
HL and fees are aid, and receipt {9 ac -
she][ be Completed In alaely day ( MOVED -IN BUILDINGS .hall be corn.
knowledged in space provided.
p!eted In !;9 menthe.)
Legal Description of Pro rty (Show Below or Attach Four Copies)
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836 E (OWN • O 'NT) DATE B3GNED
INSPECTION
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f' PER[. TEST'
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PERMI tUAfB •R
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DEPARTMENT
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CITY OF
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DATE`
� REMARKS
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v FIRE ZONE TYPE OCONSTRUCTION STREET IMPROVED
PR 6.1107
IF T:- — N4fflYiiS El NO
Any c celrucllml nn the public dumsln (clubs, eldewNk., drlveways.
SPECIAL INSPECTOR QUIRED OCCUPANCY GROUP
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GAB C] YES �' •f �' - 1
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LINE PLAN CRE KE BY NEW � THIS SITE IS LOCATED IN THE CITY
�� OF EDMONDS. LOCAL SALES TAX
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NON-RESIDENTIAL BION
ADD RETAINING EMA
D WALL
DEMOLISH
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EXCAVATE
ALTER ❑
ElFENCE
OR FILL (..........z..........Ft.)
REPAIR E] INSswim I.+ F� 1
P. OVE ❑ POOL _ �I[.� c;Z7✓J /� O/(/ S/ /G';^ //tJ���YiV%l�•�✓f
NUMBER OF STORIES I NUMBER OF
I DWELLING I
t UNITS
NATURE OF WTO HE DONE
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Fee RccctDt No.
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Plan Check N
HUILDIN6
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a, PROPOSED UHE
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isQ'-S A
W PLOT PLAN (Indicate Building setbacks, abutting street.)
HEAT & CAH LINE
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
1 heresy acknowledge that I haus read this application; that the in.
TOTAL AMOUNT DUE
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formation given Is correct; and that I and the owner, or the duly author-
ized agent of the owner. I agree to Comply With city and state laws regu.
ATTENTION
APPLICATION APPROVAL
lauag construction; and In doing the work authorized thereby, no person
will he employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
•_
relating to Workman's Compensation Inzuraaa.
AUTHORIZES
signed by the Building Official or his Dep -
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NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
HL and fees are aid, and receipt {9 ac -
she][ be Completed In alaely day ( MOVED -IN BUILDINGS .hall be corn.
knowledged in space provided.
p!eted In !;9 menthe.)
836 E (OWN • O 'NT) DATE B3GNED
INSPECTION
Dl E TOit'H ON BE A
y
DEPARTMENT
/
/
CITY OF
EDMONDS
DATE`
'
NOTE: Applicant Subject to Plan Check Fee
Thle Permit coven work to be done on private property ONLY.
PR 6.1107
_
Any c celrucllml nn the public dumsln (clubs, eldewNk., drlveways.
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RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
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Frame —/S^
Furnace Fs Fuel Lines
Final
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