680254.pdfUILDING DEPARTMENT I AppllcalatIM
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: & We HOWUrd B, Glazer
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66-73rd N
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IP NO.; PERMIT
Z4r NUMBER
gTREE•r SETBACK
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4022
COANT SITE
el YES ❑ NO
0 ONE MS EXISTING STREET R/W "1.N....FT. DEFICIENCY THIS PROPERTY
743-0246 COMP PLAN ST R/W �7Q PT.-.�.Q..HT•
REMARKS
party (show Below or Attach Four Copies)
South 10 feet thereof;
lot 8,EXCEPT North 30 feet
k 0 adowdsle Beach
to plat thereof record in
ume 5 of plate,page 38,recorda of
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New construction
Resident
g�I PROPOSED UBE
Q PLOT "Ind Bulidlni
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as/. `( I "E C0t
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Plan Check No. ...............
BUILDING
g streets) PLUMBING
HEAT k GAS LINE
PENCE
t SIGN
N
IRETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
a_ EXCAVATION OR FILL
i ---- TOTAL AMOUNT DUE
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- ATTENTION
lating construction; and in doing the work authorised thereby, no person
will be employed in violation of the Labor Code of the State of Washington THIS PERMIT
relating to Workman's Compensation Insurance, AUTHORIZES
ONLY THE
NOTE: Permif Limit One Year (Except DED(OLITIONS which WORK NOTED
eball be completed in ninety days; MOVED -IN BUILDINGS shall be coca.
plated in six months.) INSPECTION
IIONATURE (OWNER OR TA40t,7
DATE SIGNED
5/15/68 DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Su iect to Plan Check Fee Pit s-IIe7
This Permit coven work to be done on private property ONLY*
Any eaustraction
mat'Vuueesst etc ptwW domain < require s�add��sel driveways,
#103•
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Veluatlon Fee Receipt No.
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APPLICATION APPROVAL
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This application is not a permit until i
Signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
DIRECTOR'S SIGNA •{
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RECORD OF INSPECTIONS
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Date Passed
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Plumbing (Partial) 1 ( '..
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Final
' RECORD OF INSPECTIONS
Date Passed
Drainage i '
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Sewer
Parking
Landscaping
Fira Dept.
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