660575.pdfC
Is,DING DEPARTMENT
RMIT APPLICATION
LLYN C, BUSCH
4th Wav S,We
5;' Washingto
Applicant FBI
Inside HeavY Linesi �jO7:F_Ess
r7
PR -
EXISTING STREET R/W ........... XT-
COUP. PLAN ST- R/W ............ FT-
4
PERMIT
NUMBER 660516
TBACK jit-AM YARD BETBAUK
VACA14T
NO
VXLC13
E Num"Jan
a
DEFICIENCY TRIO PROPERTY
CHECKED BY
selow, or ATUICII puw I
DiVision C PERO. TEST
NEW
RESIDENTIAL
E
!IGN
NON-RESIDENTIAL
RETAINING
WALL
DEMOLISH
El ALTER EXCAVATE
OR FILL
FENCE
( ........ . x .......... Ft.)
12 REPAIR PRE MOVE
INS;.
SMM
FOOL
4UMBER OF STORIES
NO M`R"R 01'
DWELLING
UNITS
�A_T_URE OF WORK TO BE DONIS
Repair fire damaqe
Residence
YES [3 NO
Plan Check No ............
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE.MOVE INSPECTION
N OR
EXCAVATIO FILL
C—OTAL 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-
ized agent of the owner. I agree to comply with city and state laws regU-
I&Ung construction; and In doing the work authorized thereby, no VCTNOrk
will be employed in violation of the Labor Code of the State Of Washington
relating to Workmens Compensation ImurancG-
NOTE: Permit Limit one Your (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
I plated In six months.) I
11d.9 � 6�
NOTE: APPlicant Subject to Plan Check Fee
This permit coven wors, w . -one on private property ONLY -
Any construction on the public domain (curb@. sidewalklip driveways,
nmwquom etc.) will require separate Permission -
I
ATTENTION
THIS PER3=
AUTHORIZES
oNLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
Pit 6-1107
YES C3 NO
Fie I Recelpt�No.
R.,57v'49.
sn �'.
ot" a 0 6 0 1 /'0''09 K3q�9'
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.
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000N LBUILONG MMff
OF BuIMIng DepaMmwt
Appl. No.
Permit limit, one year
C*4 i�
hereby mad, for a permit tDconstruct the following work, in accordance with the accom'
_A_J' -A 4�,r a r0VA
%IM spewications. 7 sets are rr
Off -St.
... ... . . ................................................ Parking ......................
............ .............. . ....
ir:e�
e zone .... AC6 F, zo
.................... Const. type ................................ Us .......... (4e ...........................
ko(JJZ� Adan-f
v� ... BI ........ ... . ...... ....... ........ ... ..
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........................... Area ........................................... Septic tank ..... 4eae .1 .....
............ 1. side .......... 2eE ............ rear %1 .................
.............. r. side.
Ir Tel . ......... �L-8
Address.................................................... Tel. No ........... ............ * .....
........................
.................
Tel. No .............................
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............................. Address ....................................
...............................
A............................
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s an regulatin this
The above is a correct statement, and I agree to comply with all applicable Code d State laws 9
worko
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ZIP
Date ...... jr ..... A
ddress. P.L.I$ .... �.2 _7
Signed Owner/Agent.4.�.�-__._7 A . ........ .. ......
.. ... ...
above conditions, and to compliance with the ap,
for the above work is hereby approved, subject to the
proved plans and specifications, and Building Department notations therem.
Valuation ......... Lk...;ap-o ................... Permit fee ...... 4' ............. Recd. byo.
..... Da ...................................
Building Department, By ... ... .. ) .............. A,*.. te-A
NOTE — This permit does not cover plumbing, sewer, or clectrica installations, nor does it Permit any work to be
done in the Right of Way areas. Driveways and walkways MUSt be Pla"nec' to meet the official grades of streets
and alleys, and plans for future sidewalk development- V/1"
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