670035.pdfD ON KROLL MAP NO.: IT
BUILDING DEPARTMENT Applicant Fill POSTE =ER 610035
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PERMIT APPLICATION Insid Heavy Lines LOB ADDRESS 61 fv.f� A 9 � U-6of 94A"
6
USE ZONE LOT A-REA VACANT SITE
�HONE Lit t_r�Ea 13 NO
UM �] HEIGHT 13UILDING AREA VARIANCE NUMBER
) e-- e '6
I STREET R/W I
i-TELEPHONE NUMITor— EXIS77NG STREET R/W -ZS..YT. DEFICIENCY THIS PROPERTY
1 COMP. PLAN ST. R/W ............ FT. tV11 A/ C ........ 33T.
REMARKS
.5 r, ".7 S e-leeb ewleo.-1 / /7, cpZ'a
0/
CIT I TN"PHONE NUMBER
I!Re -g1P1
IQ 3 - 0 1 - a 6) 5-
or
NEW RESIDENTIAL F-1
GAS
LEI
NON-RESIDENTIAL
LINB
SIGN
ElADD
DEMOLISH
RETAINING
WALL
EXCAVATE
PENCE
ALTER
OR FILL
( x Fnl.)
PRE -MOVE
.......... ..........
SWIM
REPAIR
1:1
INSP.
El
POOL
;UMBER OF STORIES
UMBER OF
NI)WELLING
UNITS
'441 -
If
10 YES Ij ITO
0 YES [] NO
PLAN CHECKED BY
REMARKS
All construction tocomply with the Uniforin
Building Code. Meter size may be changed
to 1 1/2 in. per Public Work-s-.7—C�geE and
corrections made by plan check must carry
through. A.E.
rinn Check NS5�1._.16q
PROPOSED USE
BUILDING
PLOYT
_3�,AN (Indi, 1, abutting streets)
PLUh=NG
HEAT & GAS LINE
10
t
PENCE
SIGN
RETAINING W AT I
SWIMMING POOL
DEMOLITION
7 3
71
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given to correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to Comply with city and atato laws regu-
lating construction; and In doing the work authorized thereby, no person
ATTENTION
wIII be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTI[OIUZES
NOTE: Permit Limit One Year (Except DFMOLITIONS which
shell be completed in ninety days; MOVED -IN BUILDINGS shall be com-
ONLY THE
WORK NOTED
pleted In six months.)
INSPECTION
31ONATURE (OWNER Oft AGENT)
DATE 81GNED
DEPARTMENT
CITY OF
EDNIONDS
NOTE: Applicant Subject to Plait Check Fee
1111. 6.1107
This Permit coven work to be done on privnte property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquen, etc.) will require separate permission,
Z
Valuation I Poo I Receipt No
I _Z1,0V E- F 3. 1'16.
00
I
1/0 �7'.5-0 1
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and bees are paid, and receipt Is ac-
knowledged in space provided.
FILE
I
I
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.
'00�� __ Off -St.
ew alter
epair .... ...... Parking ......................
Work r
........................................................
c % ...... nst type ............................... Use zone..471Z ............. Fire zone. ...........................
oh , te, d
.. ... ............ ... . .......... I .... . .. .... Lot ......................... j3lk ...... I ............... Addn ......................................
Lotfrontage ....................................... Area ........................................... Septic tank ..........................................................
7/
Bldg. set -backs — front ..... A. r. side ............ . .............. ............................. ......
1. side. ............
a4_7xe�"I� .45� Tel. No.6�.Sg�:ZXS�Z
......................
Owner ................................ Address ...... ...........................
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. I
Signed Owner/
Address ............................................ Date..9�::::4.=��7_
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 .... ............... Permit fee ............ 4 . . ........... Reed. by .... L. 2"
....... ............. .............
Building Department, By .................................. Date..:!V( . ...... 46--Z� ....................
This Permit does not covcr Plumbing, Sewer or Electrical installations.