660367.pdfqt -------- .... ..
- - - - - - - -- - ------
AV
ApplIcant Fill
Inside Heavy Lines
............ N� pll�,`,_,, APPLICATION
............
t, �
to
1/'
1 -2, 2, 1? —
'FARD SETBACI
0 YES [3 NO
BUILDING
VALUATION
WORK TO BE DONE
15-
BUILDING PERMIT
2
FEE
PLUMBING
/7'
07 V -
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
n
NUMBER OF STORIES
U
M
ki
NEW
MOLI
DEn SHI
SIGN
r;;;n
5
FEE
—
DEMOLITION
ADD
LAJ FENCE
0
ALTER
RESIDENTIAL
NUMBER OF
6
PERMIT FEE
7
PLAN CHECK
DWELLING
UNITS
REPAIR
NON-RESIDENTIAL
FEE
8
AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
ATTENTION
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-
THIS PEMUT
luting constmetlon; and In doing the work authorized thereby, no person
AUTHORIZES
will be employed in violation of the Labor Code of the State of Washington
ONLY THE
relating to Workmen's Compensation Insurance.
WORK NOTED
,E,,,pl Demolitions which shall
NOTE: Permit Limit One Your be completed in ninety days.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
I NSPECTION
DEPARTMENT
12
t72.16-jl 1166
CITY OF
EDMONDS
NOTE: Applicant Stibicct to Plait Ched, Fee
PH 0-1107
This remit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewallin, driveways,
marquees, etc.) will require neparnte permission.
0 YES
13 NO
lk
[] YES [] NO
M
APPLICATION APPROVAL
This application Is not a perinit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is acknowledged In space provided.
DMEC—TOR'S �M_0041613 'n
FILE
I
APPLICATI( M & WORK PERMIT
Application No.
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 accompanying plans
and specifications:
WORK — New/Addn . ..... arl
. .......................................................... Ground Area ................................... No. Stories ............
* ------ 174-
PlansSubmitted ............................... le ... ...................................................................... Const. Type.. ...... Height ........................
...........................
LOCATION — A .... ............................. Use Zone..:r.5 ... LZ.. Fire Zone ....................
-I'
I lZress i's
RecordedLot .................... Block . ................... Add'n ......................................................................... . ..................... Sewerage ....................................
Lot Area ........................................ Wldth;:�.52!�?...:?L ...... Min. Bldg. Setbacks, Front and Rearx?.2.�.$ ....... 7 . ......... Sides...Z12v .. (:Z� ....
.................... Address ... A.7.,7 .3 ............. Phone/a
Plansby ........................................................................................... Address ....................... .1 ....... ;� ............................. Phone ................................
7
Bldg AddrdM47..- . .... :42&
by... .... &A-s� .................
Plbg. by ........................................................................................... Address ........................................................................ Phone ................................
Heatingby ....................................................................................... Address ........................................................................ Phone ................................
Elect. by ........................................................................................... Address ........................................................................ Phone ................................
Remarks fWI&XX1RXXX=XX--S-e-C ... 18-t ... Blk..27_9 ... R.4 .. Lavy .. 22-11.9 ... Code..24116 ... RT .. 2Z..REG..SE...COR..W .. 1/2 ................
NW 1/4 SE 1/4 SW 1/4 THEN N 130 TOB THEN W TOPT 195 E OF W LINE SD SUB TH N 160
..... Ta ... W ... TAET .. 20 .. F4 ... OF...W .. LN ... TH,..X ... 3JQ! .... TH...E ... naA.9.0 ... T.O...E...W ... S-D ... SUB ... TH...S ... RK..P.OB . ...............................................
..................................................................................................................................................................................................................................................
------ ---- ------- ------------ ------------ - ..... ......... .................................................................................................................................................
The above Is t statement and I agree to comply with all applicable Codes and State Laws regulating the work.
Signed: Own dress ............................................................................ Date.
e
PERMIT for the abo T rk Is hereby approved,, subject to the above conditions, and to compliance with the approved plans
and specifications and Bu 71ding Department notatfons thereon.
VALUATION PERMIT ITMES
...... Bldg. $ .............. .......
PIbg. $ ........................................
APPROVED: Heat .... $ ........................................
Date.............. ...-) .................................. Elect. $ ........................................
BUILDING DEPARTMENT Others ... $ ........................................
B1 . dg I n . s p.. . , ................... TOTAL F EU $ ........... ..........
... .......... . .........
NOTES: No work requiring Building Department or City Engineer's 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.