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710402.pdfz U BUILDING DEPARTMENT I AilpucantFIB PERMIT APPLICATION Inside Iieavy Lines 40 U n of Properly (Show Belowl or f � -C' Al / .l„ " o - 7 — ��y— 'OSTED ON KROLL MAP NO.: PERMIT NUMBER � � OH ADDRESS �/V11o+r (p U O• '�L 1. ' TIDE YARD ET13ACK`I STREET SETBACK REAR YARD SETBACK USEZONE es—tl� LOT AREA I I VACANT SITE El YES NO ITEIGHT I BUILDING AREA I VARIANCE N�BER PLOT PLAN AP VED p'� /51 L 2-1. oti /lord OJT. ,�t! STREET R/W EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY COMP. PLAN ST. R/W ............FT. - ............FT. REMARKS CHECKED BY METER SIZE I SERVICE SIZE I CLEARANCE I CHECKED BY REMARKS Cxrs� TYPE CONNECTION I VERIFIED BY PERC. TEST I PERMIT NUMBER REMARKS /, FIRE ZONE . I TYPE OF CODOTRUCTION, STREET IMPROVED SPECIAL INSPEECGAS yTOR ❑PLAN SCHEC,D ❑ NEW ADD ❑ ALTER ❑ REPAIR ® ❑ ❑ ❑ ❑ RESIDENTIAL NON-RESIDENTIAL DEMOLISH EXCAVATE OR FILL N.PRE-MOVE ❑ ❑ ❑ ❑ ❑ LINE SIGN RETAINING WAIT' FENCE (.......... x.......... Ft.) PWIM OOL BY REMARKS &JL W O cd M pU Ati 1Y �-{ �' 1 /•� F' (UMBER OSTORIES NUMBER OF DWELLING % UNITS / Ze x 2 CITY OF ICE= IP T- Valuation Plan Check No ..................... BUILDING PLUMBING HEAT & GAS LINE FENCE SIGN RETAINING WALL N ISWIMMING POOL DEMOLITION PRE -MOVE INSPECTION EXCAVATION OR FILL TOTAL AMOUNT DUE I hereby acknowledge that I have read this application; that the in- formation given In correct; and that I am the owner, or the duly author. tzed agent of the owner. I agree to comply with city and state laws regu. ATTENTION lating construction; 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 relating to Workmen's Compensation Insurance. AUTHORIZES NOTE: Permit Limit One Year (Except DEMOLITIONS which ONLY THE WORK NOTED shall be completed In ninety days; MOVED -IN BUILDINGS shall be com. pleted in six months.) SIGN TULLE (OWNER Olt AGE ) E SIGNED INSPECTION , DEPARTMENT v Lg?,;7-71 CITY OF EDMONDS NOTE: Applicant Seplect to Plan Check Fee rn o-IIOI This Permit cohere work to be done on private property ONLY. Any construction on the public domain (curbs, sidewalks, drIvewR7s, marquees, etc.) will require separate permission. 24 ❑ YES -�&`NO ' GROUP IS LOCATED IN TIC IONDS. LOCAL SAI .D BE CODED 31.0 'To U19c 11470. Fee E6 I/ - W 3 No. APPLICATION APPROVAL • This application is not a permit until signed by the Building Official or his Dep- uty; and fees are paid, and receipt is ac- knowledged in space provided. FILE c i A i APPLICATION oa BUILDING PERMIT Appl. No./..z.-......... CITY OF EDMONDS Building Department Permit limit, one year APPLICATION is hereby made for a permit to construct the following work, in accordance with the accom- panying plans and specifications. Two sets are submitted herewith for approval. Gna alter � fJ � ' Off -St. Workrepair -... ........... ............ .. ....................... Parking; ...................... ! Occupancy ................................ nst.�type Use zone..... ...... Fire zon �r �r-�.�,.•-fir � �` Address��........... .......... :...... Lot ...... - Blk..�.. Addn. J' L� � Lot frontage ............. Area .....(,1.. c!..,i(...I-/ I ........ Septic tank ..... f'� ......... t< ' i Bldg. setbacks - front........ 36 ..........0 . r. side ..... et...... ........ 1. side..... 1P................ ear ...:_. ............. Owner.. ............... Address . Z yG?/��(. ...... Tel. rNo.�,-•y.!i� ............. C L r Builder ...... .... ........... ....... ........ `......... Address: ...... ................. ........ Tel. No....; Plansby .........' .................................................... Address. .................... ......`......... Tel. No....: ............................. Remarks......................................................................... The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this work. Signed Owner/Agent.. ........ Address..... y. �� l �r . Date. L ............L z' . PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the ap- proved plans and specifications, and Building Department notations thereon. Valuation ...........��.I �v7 Permit fee ...... rr Recd. by..5 Building Department, By ............................................. %, d_41.......... Date. `3 ,? ,-1..... . . ............................. This Permit does not cover Plumbing, Sewer or Electrical installations.