750361.pdfj 7�03(.:el
(. RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
(Rough) -----
Frame
P Furnace & Fuel Lines
Final A5 —/,j G /.
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�I I lNt/�.tEl"T.l' ll. yr
jj DATE:
STREET R/W
EXISTING ST93EET R/W ............Fr.
DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT.
..........-FT.
REMARKS
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CHECKED BY
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Pian Check N
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BUILDING
PROPOSED USE
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PLUMIIIN6
BUILDING DEPARTMENT
AppUcant Fill
USE
USE
ZONE '� C.
PERMIT lY'-' -"`.._•.1 .'i .�
NUMBER ' i : ? '' • ' � �
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PERMIT APPLICATION
I Inside Ifeavy Lines
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110.1
SIGN
RETAINING WALL
ADDREBB
N
NAME (OR NAME OF BUSINESS)
'{, CV
DEMOLITION
PRE -MOVE INSPECTION
PERMISSIBLE 7.
ACTUAL
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_
LOT COVERAGE '
- LOT COV aAOE
I hereby acknowledge that I have read this application; that the In-
d' MAILING ADDRESS"
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_
Irrdagent of the owner. I agree to Comply With City and elate laws regu-
ATTENTION
APPLICATION
PERMI8d)B{.E HEIGHT
PROPO GHT
/HE
O
Will be employed In violation of the Labor Coda of the State of Washington
THUS PERMIT
`• ,•.
relating to Workmen's Compensation Insurance.
AUTHORIZES
Signed by the Building Official Or Ids Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TIRE
WORK NOTED
CITY
TELEPHONE NUMBER
ACTUAL LOT AREX-_ _ TOTAI. B O. AREA
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Imowledged In space provided.
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fueled In elx month,.)
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REQUIRE YARDS `w. PROPOSED YARDS
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DIRECTOR', SIGNATURE
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NAME
yADDRESS
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CITY I TELEPHONE NUMBER
NAME
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[O ADDRESS
C CITY) TELEPHONE NUMBER
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Q -YES NO PERMIT NUMBER
�I I lNt/�.tEl"T.l' ll. yr
jj DATE:
STREET R/W
EXISTING ST93EET R/W ............Fr.
DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT.
..........-FT.
REMARKS
NATURE OF WORK TO BE DONE
CHECKED BY
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GAS
It' --..TIAL LINE
NEW I El�
Q NON-RESIDENTIAL SIGN
E] ADD RETAINING
DEMOLISH WALL
ALTER ❑ EXCAVATE ❑ FENCE"
OR FILL (.......... x .......... Ft.)
REPAIR PRE -MOVE 8WI11
INSP. POOL
YES Q NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
Q YES ' NO rf'
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
REMARKS SHOULD BE CODED 3104
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"10 _, (-(, 1�"
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NUDIBER OF eTOR1E8 NUDiBER OF
I DWELLING
/ UNITS
NATURE OF WORK TO BE DONE
Valuation Fee Receipt No.
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Pian Check N
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BUILDING
PROPOSED USE
O
PLUMIIIN6
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
z�FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
1 -
TOTAL AMOUNT DUE
f y T C}
I hereby acknowledge that I have read this application; that the In-
formation given In correct; and that 1 nthe owner, or the duly author-
Irrdagent of the owner. I agree to Comply With City and elate laws regu-
ATTENTION
APPLICATION
latlns eonetructlon; and In doing the work authorised thereby, no person
APPROVAL
Will be employed In violation of the Labor Coda of the State of Washington
THUS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
Signed by the Building Official Or Ids Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TIRE
WORK NOTED
ut and fees are Bid, and receipt I9 6C -
y� P p
shall be completed In ninety days; DROVED -IN BUILDINGS shall be com-
Imowledged In space provided.
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fueled In elx month,.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
DIRECTOR', SIGNATURE
d
I
CITY OF
EDMONDS
DATE
NOTE: Applicant'Subject to Plan Check Fee
! —� f —' 7•= -•--- 1 (.-
S /
775-2525
1.
Thls Permit carers work to he done o Private
n f fulk., d ONLY.
Any construcllon on tho public domain (curbs, eldewWke, driveways.('
mivem'rx, rtt•.1 "In .rani N' sr Vnrnlr prnul+elan.
INSPECTOR
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7�o3c�1
RECORD OF INSPECTIONS
Data Passed
Foundation
Plumbing (Partial)
(Rough)
Frame
Furnace & Fuel Lines
Final /s -' 7 G