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RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)'
(Rough)
Frame
Furnace & Fuel Lines
Final
a
1
I
I (n�
��. BUILDING DEPARTMENT ONE NUMBPERMER
740
Appacant FIa I.! (j
PERMIT APPLICATION Imide Heavy Llnoe ADDRESS
/ O /
N ME lOR NAMF O
C - PEMltl8I8LE ^,( ACTUAL
a,.(J LOUT COVERAGE LOT COVESgAOE �I
0} AILING ADDR 6
{'• �.�'� PERMISSIBLE HERMIT PROPOSED IIEIGHT
al73o- Sll— Ccl.
[ NAME
aUy,l ADDIU1111
U
aC C1TY
NAME
SS
ADDRESS
y IGS pn9 - �
e7 C1TY
8 (.y1'y�p�
STATE LICENSE NUM E
__0.3k_il9_r
ACTUAL LOT AREA TOTAL BLDG. A EA
0 YES [:I NO
REQUIRED YARDS PRUPOSEU YARDS
�!
FRONT NIDE REAR( FRONT ODE HEAR
GROUP
•j I
RESIDENTIAL
r
LEGAL LOTAIIIANCE 011 CONDITIONAL UAE
)
YEA 1, NO PERMIT NUMBER
1
i
PLANNING DEPT. APPROVAL DATE:
PLAN CHECKED BY
1
STREET R/W
D
NON-RESIDENTIAL
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
OF EDMONDS. LOCAL SALES TAX
COMP. PLAN ST. R/W ............FT. ............FT.
1
REMARKS
i
W
I1
!
REMARKS
CHECKED HY
(
F] ALTER EXCAVATE ❑ FENCE
'I
METER SIZE
I SERVICE SIZE I CLEARANCE
I CHECKED BY
swim
REPAIR ❑ IN PMOVE POOL
REMARKS
NUMBER OF STORIES
NUMBER OF
TYPE CONNECTION
I VERIFIED BY
a.
PERC. TEST
PERMIT NUASHER
REMARKS
UNITS
Any m.idruerma on — v_. __
ntareuu., eR.) trill reonire separate Duminlon.
FILE
0 YES [:I NO
SPECIAL INSPECTOR REQUIRED
GROUP
RESIDENTIAL
OAS
❑ YES NO
IOCCUPANCY
1
NEW L—
LINE
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
OF EDMONDS. LOCAL SALES TAX
1
SIGN
SHOULD BE CODED 31.04,
,
El ADD O DEMOLISH O WA?I iININC
REMARKS
F] ALTER EXCAVATE ❑ FENCE
❑ OR FILL (.........X .......... Ft.)
swim
REPAIR ❑ IN PMOVE POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
'
UNITS
NATUREWORK TO HED
Valuation
Fee Receipt No.
•
Plan Check N. .....................
BUILDING
PROPOSED USE
PLUMHIN6
PLOT PLAN (Indicate Building setbacks, abutting .tmete)
HEAT A GAS LINE
FENCE
SIGN
_
1
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
I
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have road lila application; that lila In-
formation given Is correct; and that I am the owner, or the duly author,Red
agent of the owner. I agree to eoneDly'with city and elate law. regu•
ATTENTION
APPLICATION APPROVAL
I.tmg conitmetlon;and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
relating to Wontmen•s Compenention Insurance.
AUTHORIZES
signed by the Building Official or lila Dep -
NOTE: Permit Limit One Year (E.cept DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac -
sial a complated In ninety day.; MOVED -IN BUILDINGS shall he coni•
lmowledged in Space provided.
p ed .1% n a .)
ONA RE DWN R AGENT)
D
INSPECTION
DIRE K'8 HIQNATUR
/
DEPARTMENT
ZY.N
-
CITY OF
EDMONDS
—DATE
(qf'E: ApQlicant Subject to Plan Check Fee
PR 6.1180
-/
Any m.idruerma on — v_. __
ntareuu., eR.) trill reonire separate Duminlon.
FILE
ai A REBS
CITY "LEPIAONZ N
NAME ro
o
W ADDRESS
ta(toUido;,
TZLEPHONID F
STATE LICENSE NUMBER CIT LICENSg
RESIDENTIAL LINE
NEW ❑ NON-RESIDENTIAL ❑ BION
ADD RETAI
❑ DEMOL8H O WALL KING
ALTER ❑ OR
ROFILLTE ❑ (ENCx.......... Ft.)
REPAIR F1INSP. ❑ PWIM
OOL
VUMBER OF STORIES I NUMBER OF
DWELLING
UNITS
FRONT NIDE RF;AR FRONT blue i
LEOA1. LOTVARIANCE Olt CONDITIONAL UBE
I
YES NO PEItM1IIT NUMBER !
DATE:
ANNING )EPT. APPROVAL
Plan Check No.. ....... ...........
I
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
HUILDIN6
i
COMP. PLAN ST. R/W ............FT. ............FT.
l
01
1
am
BUILDING
DEPARTMENT ApplicaILines
UBE
ONE
NUMBER
N
PERMITAPPLICATION
Inside HeaO
,
FENCE
rDDRESSInBUB
METER SIZE SERVICE SIZE
CHECKED BY
SIGN
NESS)
� I(,_ iIOT
ill hilBtl BLl•: r�'
COVERAGES
tRETAINING
N.—
viJ.CTUAL
NaNINISIBLE HN—i-I
3
r
I .....OtlEU IIEIOI
(VERIFIED
r
SWIMMING POOL
• y I
LOT AREA
ILEQUIRED YARD8
7'OTAI. BLUO. AP
PROPON
ai A REBS
CITY "LEPIAONZ N
NAME ro
o
W ADDRESS
ta(toUido;,
TZLEPHONID F
STATE LICENSE NUMBER CIT LICENSg
RESIDENTIAL LINE
NEW ❑ NON-RESIDENTIAL ❑ BION
ADD RETAI
❑ DEMOL8H O WALL KING
ALTER ❑ OR
ROFILLTE ❑ (ENCx.......... Ft.)
REPAIR F1INSP. ❑ PWIM
OOL
VUMBER OF STORIES I NUMBER OF
DWELLING
UNITS
FRONT NIDE RF;AR FRONT blue i
LEOA1. LOTVARIANCE Olt CONDITIONAL UBE
I
YES NO PEItM1IIT NUMBER !
DATE:
ANNING )EPT. APPROVAL
Plan Check No.. ....... ...........
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
HUILDIN6
;
COMP. PLAN ST. R/W ............FT. ............FT.
[[yy
ly PROPOSED UBE
REMARKS
1
am
PLUMBING
C
.-.�
W PLOT PLAN (Indlcote Building setbacks, abutting etroete)
N
j
-CLEARANCE
CHECKED BY
FENCE
l
METER SIZE SERVICE SIZE
CHECKED BY
SIGN
tRETAINING
N.—
N
3
r
TYPE CONNECTION BY
(VERIFIED
r
SWIMMING POOL
PERO. TEST PERMIT NUMBER
DEMOLITION
I
REMARKS
I 't
i [3 YES ❑ NO
OR REQUIRED I OCCUPANCY GROUP
NO i
Y THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04...._
`�7 •� •tnv.• __ •., -
Plan Check No.. ....... ...........
D—�--
HUILDIN6
[[yy
ly PROPOSED UBE
1
am
PLUMBING
rEE
.-.�
W PLOT PLAN (Indlcote Building setbacks, abutting etroete)
HEAT & GAS LINE �:
'OJ '\ I• ) ,
FENCE
SIGN
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
[ hereby acknowledge that I have read thin application; that the In-
NNN l Fi
formation given to correct; and that I am the owner, or the duly author-
lred agent of the owner. I ogre. to comply with city and elate lawn mgu-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorised thereby, no person
will be employed In violation of the Labor Code of the State of waahington
TIDE PERMIT
This application is not a permit until
relating to workmen's Compensation lasuraaoe.
AUTRORIZE8
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt Is ac-
ehall-" comPleted,In bluely dayn; MOVED -IN BUILDINOS shall be corn.
knowledged in space provided.
pitted 11 els month..)
�
S% NA HE (OWINER.OR AGENT)
DATE GNED
/
INSPECTION
DEPARTMENT
DIR CTOR'B B ATU E
, /'/1 �/
j✓'iGl"% ',,;r;:�-.—_�
CITY OF
EDMONDB
DATE l
NOTE: Applicant Subject to Plan Check Fee
Pn a -Aloe
Wi Permit coven work to be done on private property ONLY.
Any construction oa the public domain (curbs, oldewalks, driveways,
INSPECTOR
mareueen, els.) wW rcomre .,pante parolulon.
cy
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... .... . ....
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7, T
RECORD OF INSPECTIONS
batePassed'
cy
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