670064.pdf..... ......
BUILDING DEP,ARTM Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAT61 (OR NAM OF BUSINESS)
,4!57/,J� /77 &S
MAILING ADDRESS
1.4 1—h
CITY TELEPHONE NUMBER
oe�_Olma -2
NAME
ADDRESS
,AP.6— —
CITY wxj�FHVNE NUMBER
LCAY? 0 ,? 1:6
NAMM
or
Zoo 7�� Ze_'�wl_q
,4dd- 1W CQ11
!D ON KROLL INIAP NO.: PERMIT
Numn;m670064
DDRESS'
IF, - 7,11 6 —
YARD SEVrBAC TR SETBACK ItNAlt XARD SETBACK
AREA V
ZONE LOT ACAWT SITE
3 -YES 13 NO
WMA NUMBER N
11tElpT,R/W
D13STING STREET R/W ............ FT- DEFICIENCY TWO PROPERTY 0
COMP. PLA.N ST. R/W ....... ....
LEMARKS
it 'CHECKED 33Y Z
.7 /
�Zq ,
I
FIRE ZONE TYPE OF CONWXICUCTION "��v v
NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES MTO
PLAN CHECKED,BY
GAS
D L.INN
ErNEW S
REMARKS
RESIDENTIAL
.8
N R!
ON -RESIDENTIAL SIGN
DADD ... RETAINING
WALL
DEMOLISH
ALTER EXCAVATE PENCE
OR FILL ( .......... X .......... Ft.)
PRE -MOVE SWIM
El REPAIR INSP. POOL
NUMBE I OF STORIES NUMBER OF
DWELLING
/r G1 /y el,
.1 UNITS
I
NATURE OF W015�'_TO BE DONE
lye vv
Valuation Fee Receipt No.
Z
0
Plan Check No .....................
PROPOSED USE
BUILDING
P
T PLAN (inurnale Building nJback!,_0utt1ng stre I
74 op r_�7
PLUMBING
G
JLJNE
HEAT & GAS
r%
PENCE
SIGN
N
RETAINING WALL
SWI3,IMTNG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL 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-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no person
In violation Of the Labor Code of the State of Washington
THIS PERMIT
This application is not a perinit until
will be employed
relating to Workmen'O Compensation Insurance.
AUTHORIZES
signed by the Building official or his Dep-
NOTE: Permit Umit one Year (Except DE31OLITION'S which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
shall be completed In ninety days: MOVED -IN BUILDINGS shall be com-
knowledged in space provided.
pleted In six months.)
SI ATURE (OWNER 'DR AGENT) NJ$D
INSPECTION
DEPARTMENT
DIRECTOR'S SIGNATURE
CITY OF
DATE
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
Pit 0-1107
This permit covers work to be done on private property ONLY.
Any construction On the public domain (curbs, sidewalks, driveways,
FILE
marquees, etc.) will require separate Permission.
I