650034 (2).pdf01
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NEW
ADD
ALTER
REPAIR
I
C� 61 0
DEMOLISH
.' 4��
RESIDENTIAL NTxJL=0F
NON-RESrDENTIAL UNITS
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 BtatO lawn regu-
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
relating to WorkmeWs Compensation Insurance.
NOTE: PERMIT LIMIT ONE YEAR
IIGNATU Ti�(07ER_CR �A59�4T) I MATE -BIGNED
MLE
0
PLAN FILE NUMBER 13UILDING
Applicant Fill PERMIT r
..Building Permit Application Inside Heavy Lines NUMBER
NAME (OR NAME OF BUSINESS) JOB ADDRESS
7;�P r`�7.-`
MAILING "DRESS SIDE YARD SET BACK
REAR TARD
1P. 3
TELEPHONE NUMBNA
CITY USE ZONE AP NUMBER ANT SITE
VAC
7�
[] YES 0
M// t/ I -U�tp I
NAME BUILDING AREA LOT AREA VARIANCE NUMBER
ADDRESS
_.&LL BUILDING SETBACKS ow
114%11 C: To
CITY
TELEPHONE NUMBER MARKS
Did not build- Called in on 9 1 Ar.
NAME
*7
(AE)
A1111y Encroachment Permit PERMIT NUMBER ___ STREET GRAME CHE
uIred
CITY TELEPHONE NUMBER NO
§7 METER S RVICE SIZE CLEARANCE
CILECKED -Mr-
ell,
8
STATE LICEUSE NUMBER CITY LICENSE NO.—.. REMARKS
LOT BLOCK TRACT
TYPE CONNECTION VERIFIED By.
PERC. TEST PERMIT NUMBER,
FIRE Z070�7
E OF CONSTRUCTION
STREET, IMPROV E
C] YES 13 No
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
0 YES NO
PLAN CHECKED By
WORK'JTO BE DONE
NO. OPOLOGS. PERIBLOG. TOTAL FEE
BUILDING
VALUATION
BUILDING PERMIT
IZI
NUMBER OF 2 FEE
STORIE
NEW El DEMOLISH PLUMBING
[:�7/ 3 PERMIT FEE
ADD
HEAT & GAS LINE
1:1 ALTER I El RESIDENTIAL 4 PERMIT FEE
NU R OF
DA r=ING
R PAIR DEMOLITION
71 111
r E NON-RESIDENTIAL UNITS 5 PERMIT FEE
—PROPOSED USE
AMOUNT DUE
/A_
_"N
I hereby acknow
t 1-iha'v.e"'r�e��:.it�i"it�p)plleELtion; that the In-
, formation 9 ATTENTION
�en i 9 ggrrect;,And that I am the owner, or the duly author- APPLICATION APPROVAL'�
Ized tvW C�A elr;rlikgree to comply with city and state lawn regu- THIS PERMIT
lating consfiVetiSn'. iiiii-ld'doing the work authorized thereby, no person AUTHORIZES This application is not a perrhit' ultil
will be employed In violation of the Labor Cqdoj?�,,,��e slgned�by the Director of Building'Inspee-
,8ttto of Washington ONLY THE
reiating to Wo-iiiiiiii'i'C6izipensation. Insuia'&V.- WORK NOTED tion, or his deputy; and fees are pald,and,,'
receipt is aelmowledged in space provided.
NOTE: PERMir"-LIMIT'6WCytA*1
SIGNATURE"(OWNER'*OR INSPECTION DIRECTOR'S BIG
-AGE DATESIGNED NATURE
DEPARTMENT
. ..... �Jil
CITY OF
EDIVIONDS DATE'
CHECK eAPPROVED
PL,OT-PLA.N
PR 6-1107
INSPECTOR
I
41
0i APPLIOATION BUILDING PERMIT
CITY,OF EDMONDS. Building Departmeft ''Pirmit lim.
%:one year...
APPLICATION is hereby made for a permit to construct the following work, in accordance with the'accom,
panying p for ap
tans and specifications. Two sets are submitted herewith prmal.
new --alter Off -St.
Kriin
Work addn repair �i ..... ............. .....................................................
k ...... . .. . ......
...... ............. . 0
7 Occupancy ............. ;5 ............. Const.. type ............. r ......... Use zone .... 6. A-0 .... Fire.zone ..........
Address .......... re. )-e. Z� ........................ Blk ........................ Addn .......... ..........
.. . ........... ..
Lot frontage ... ..... ............................. Area ........................................... Septic tank ......................... L .............
..........
Bldg. set -backs front.
..... . .................... r. side ........... 1. side ............
:t ... rear ............ ...............
e el- A
OwnevAl. ...... Address. .....................
............................. ..........
Bader.
........ Address .. . ..................... ........... .
.. ............ Tel. No ................
Plansby ..................... ............................................ Address ..............................
..................... Tel No; ...........................
Remarks ...............................
.............. . .................................................................................
................................. ...... ..........