740102.pdfPERMIT
NUMBER
1058 Daly Street
Plan Check No.. ...................
I
----------------
FRONT SIDE REAR FRONT
BIDE REAR
BUILDING DEPARTMENT
AppucantFill
°NE
LINE
PERMIT APPLICATION
ADD
Inside Heavy Linea
I
DH
ADDRESS
ADDRESS
NAME (OR NAME OF BUSINESS)
USE
RETAINING
WALL
..��
ALTER
OR FILL E
❑
Steven Vierthaler
PERMIBSIBLI
LOT COVERA
HEAT & GAS LINE
MAILING ADDRESS
PLANNING DEPT. APPROVAL
DATE:
PERafISSIBLI
(UMBER OF STORIES NUMBER OF
c
1058 Daly Street
DWELLING
CITYTELEPHONE
NUMBB:R
ACIUAL LOT
UNITS
Edmonds Washington
fATURE OF WORK TO BE DONE
REQ
PERMIT
NUMBER
1058 Daly Street
Q ADDRESS
a0
F CITY TELEPHONE NUMBER
7:
p METER SIZE
Plan Check No.. ...................
NAME
❑
FRONT SIDE REAR FRONT
BIDE REAR
NEW
xau+
[y
LINE
ADD
NON-RESIDENTIAL
N
ADDRESS
LEGAL LOT VARIANCE OR CONDITIONAL
0 YE NO PERMIT NUCONDITIONAL
USE
RETAINING
WALL
..��
ALTER
OR FILL E
❑
FENOx..........Ft.)
❑
HEAT & GAS LINE
PLANNING DEPT. APPROVAL
DATE:
swim
(UMBER OF STORIES NUMBER OF
CITY
TELEPHONE NUMBER
DWELLING
SIGN
UNITS
STREET A/W
fATURE OF WORK TO BE DONE
N
COMPLIANCE INSPECTION
EXISTING STREET R/W ............FT. DEFICIENCY
THIS PROPERTY
NAME
DEMOLITION
PRE -MOVE INSPECTION
COMP. PLAN ST. R/W ............FT. ............FT.
EXCAVATION OR FILL
OMP. INSP.
REMARKS
25.00
Q ADDRESS
a0
F CITY TELEPHONE NUMBER
7:
p METER SIZE
YES [3 NO
THIS SITE IS L
OF EDMON DS.
0 YES [] NO
Fee I Receipt No.
Plan Check No.. ...................
RESIDENTIAL I
❑
0
NEW
xau+
[y
LINE
ADD
NON-RESIDENTIAL
❑
SIGN
DEMOLISH
PLUMHIN6
RETAINING
WALL
ALTER
OR FILL E
❑
FENOx..........Ft.)
❑
HEAT & GAS LINE
REPAIR ❑ INSPMOVE
❑
swim
(UMBER OF STORIES NUMBER OF
O
FENCE
DWELLING
SIGN
UNITS
RETAINING WALL
fATURE OF WORK TO BE DONE
N
COMPLIANCE INSPECTION
YES [3 NO
THIS SITE IS L
OF EDMON DS.
0 YES [] NO
Fee I Receipt No.
Plan Check No.. ...................
0
[y
BUILDING
PROPOSED USE
O
PLUMHIN6
aPLOT
PLAN (Indicate Building Setbacks, abutting streets)
HEAT & GAS LINE
7
O
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
OMP. INSP.
25.00
I hereby acknowledge that I have rend this aDDlleatlon; that the m-
TOTAL AMOUNT DQE
25.00
formation given IS correct; and that I am the owner, or the duly author-
/
-
lzed agent of the owner. I agree to comply with city and .tate law. raga -ATTENTION
Iating construction; and In doing the
APPLICATION APPROVAL
work authorized thereby, ao Person
will be employed In violation of the Labor Coda of the Btele Of Wuhlogton
to Workmea'.
THIS PERMIT
This application is not a permit until
relating Compensation In.urabw.
NOTE: Permit Limit One Year DEMOLITIONS
AUTHORIZES
ONLY TILE
signed by the Building Official or his Dep.
(Except which
WORK NOTED
uty; and fees are paid, and receipt is ac -
.hall he completed In Wooly day.; MOVED -IN BUILDINGS shall be Som•
knowledged in apace provided.
Oleted In .Ix months.)
SIGNATURE (OWNER OR AGENT) 7DATE SIGNED
INSPECTION
DEPARTMENT
Dl�IGNAT U
ORS S-,
MO ta Cor —8-74
�7Q�r
CITY OF
%
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
_
This Permit co work to be done oD Drivate property ONLY.
Any eonatruc/1" on the public demnin (curb., nIdrwalk.. driveway.,
utra4cca etc.l lrlL --c ...brute Iruad.alun.
DILE
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RECORD OF INSPECTIONS t
Date Passed
Foundation ----
Plumbing (Partial) -----
(Rough)
t
,Frame
'Furnace St Fuel Lines-------
FinalI'
it
,
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