650145.pdf- ---- ----- --
PLAN FILM NUMBER
PERMIT
Applicant Fill 6 014.5
Building Permit Applicationj Inside. Heavy Lines NUMBER
N ME: (OR NAME OF BUSINESS) HESS
JOB ADD
z�72X
MAI ADDRESS SET BACK REAR YARD
SIDE YARD
LING
A��y NE _R VACANT SITE
C VTE HONE NUMBER USE ZONE MAP NUM
Aa-5, &)AJ. Wf-tf,924' 0 YES [3 NO
NAME BUILDING AREA LOT AREA VARIANCE NUMBER
ADDRESS HEIGHT ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
TELEPHONE NUMBER REMARKS
Of
SS Encroacpfent Permit T NUMBER STREET GRADE CHECKI's
Required
YES NO 14
T HONE NUMBER METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
CENSE NUMBER CITY LICENSE NUM13
BLOCK TRACT
TYPE CONNECTION VERIFIED BY
PERO. TEST PERMIT NUMBER
TYPE OF CONSTRUCTION STREET IMPROVED
FIRE ZONE
YES NO
Z
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
0 YES NO
PLAN CHECKED BY
WORK ONE NO. OFr BLOOS. PERIBLOG. TOTAL OrKM
BUILDING
I VALUATION
BUILDING PERMIT
2 FEE
NUMBER OF STORIE :2
NEW DEMOLISH
El PLUMBING
ADD 3 PERMIT FEE
BEAT & GAS LINE
ALTER k�Nj, RESIDENTIAL R or 4 PERMIT FEE
M�ZE
LING
REPAIR NON-RESIDENTrAL UNITS DEMOLITION
El 5 PERMIT FEE
PROI
AMOUNT DUE
I hereby acknowledge that I have read thin application; that the in-
formation given in correct: and that I am the owner, or the duly author- ATTENT1014 APPLICATION APPROVAL
ized agent of the owner. I agree to comply with city and state laws regu- THIS PERMIT This application Is not a permit until
lating construction: and in doing the work authorized thereby, no person AUTHORIZES signed by the Director of Building Inspec-
will be employed in violation of the Labor Code of the State of Washington ONLY THE
relating to Workmen's Compensation Insurance. WORK NOTED tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
NC(TE P!PAR Ll T ONE YEAR
INSPECTION
S::: 17AT 8 NED
DEPARTMENT
CITY OF
PLOT PLAN CHECK & APPROVED Pn 6.1107
FILE
I
APPLICATI�-,N & WORK PERMIT
CITY OF EDMONDS Building Department
Application No.
Permit Limit, One Year
OPLICATION is hereby made for a permit to construct the following work, in accordance with the accompanying PlOm
specifications:
.............................. NO. Stories ............
ORK New/Addn . .................................................................................................... Ground Area .....
ress
x2eigh .......................
................................................ Li!i;0 ........................ Const. Type ........................................
...................................................
U ................
se Zone ...... Fire Zone ....
Block. ................... Add'n ... .. ........................
Zif-
f ....... / .........
Sewerage ....................................
. ............ Width. ........................... Min. Bldg. Setbacks, Front and Rear..Y. VYdes .................. f ..........
7�e6
J% ...................... Phoncr ....................... .....
-- ------- .. .. Address.
Address........................................................................ Phone ................................
.........................................................................
. .. . . . ................................................................................ Address .................................. 14�.. ..... . ....... Phone ................................
......................................... ............................... Address ........................................................................ Phone .................... ......... .
------ ---------------------------------------------- Address ........................................................................ Phone ................................
&ddress ........................................................................ Phone ................................
........................................................................................... ........................................
....................................................................................................................................
------------ -----------------------------
I
The above is a correct statement and I agree to comply with all applicable Codes and State Laws regulating the work.
Signed: Owner/Agent .............................. 2!� ................ Address ...... zllalic� �.. ........... ..... .................. Date ... (P.
plans
PERMIT for the above work Is hereby approved, subject to the above conditions, and to compliance with the apprioved
and specifications and Building Department notations thereon.
VALUATION FERBUT FEES
Bldg............................. ......................................
Plbg. .... .........................................
APPROVED: Heat .... $ ........................................
(a Elect. ............ . .......................
Date ..... ....... ...........................................................
BUILDING DEPARTMENT Others $ ........................................
By ...... TOTAL FEE $
...................................
NOTES: No work requiring B g Department or Cit�/Engineerls inspection shall be covered before inspection and approval.
Twenty-four (24) hour notice requested. Contact the City Engineer prior to construction of all site utilities, such as
curbs, paving, driveways, sewer, water and street connections.