670148.pdf0
'J,
BUILDING
DEPART MENT
PERMIT
APPLICATION
NAME (OR NAME OF B USINESS)
Ul., t
G DRESS
14
CITY
NAME
AD BESS
CITY
ADDRESS
or
Applicant F111
inside Heavy Lines
C-1
NEW
RESIDENTIAL
D
GAS
LINE
NON-
SIGN
ADij
E]
DEMOLISH
RETAINING
WALL
ALTER
n
MCCAVATM
OR FILL
FENCE
( ........ . x .......... Ft.)
REPAIR
n
Pl%E-MOVE
INSP.
swim
POOL
.IUM13ER Ap R�nRiirR
OF Wxu��o
'I
NUMBER OF
DWELLING
UNITS
rMSTING STREET R/W ... ........ FT.
coMP. PLAN ST. R/W . ...... FT.
[J YES [] NO
Plan Check No ............ . ......
Pitof= BUILDING
PLOT PUAN (indicate Building setbZks, _RbUttlng streets-) PLUMBING
BEAT & GAB LINE
PENCE
t SIGN
RETAINING WALL
J1_" I -
D SWIMMING POOL
DEMOLITION
V
PRE -MOVE INSPECTION
ExcAVATION OR FILL
TOTAL AIMOUNT DUE
I hereby acknowledge Mat I have read this application; that the in-
formailon 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 rOgU- ATTENTION
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT
relating to Workmen,p Compensation Insurance. AUTHORIZES
ONLY Inm
NOTE: Permit Limit one Year (Except DEMOLITIONS which AVORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com.
picted in six months.) INSPECTION
------- �T)D—ATEE SIGNED
31ONATURE (OWNER OR AGEN DEPARTMENT
Z�;? W OF
EDMONDS
NOTE: APPlicant Subject to Plan Cbeck Fee rn e-iio7
This rermlt covers woric w m none an private property ONLY -
Any construction an the public donuLln (curbsp sldewalks� drivewayst
marquees, etc.) will require separate Permission -
PERMIT
NUMBER. 670148
iiF YARD SETBACK
YES E3 NO
:j�"- am I-TUMBER
DEFICIENCY THIS PROPERTY 0
.......... FT.
Valuation
13 YES
A , o
NO
Z'
t�4(0 0
APPLICATION APPROVAL
This application is not a pernlit until
signed by the Building Official or his Dep-
uty; and fees are paido and receipt Is ac-
knowledged in spme Provided.
DIRECTW-EL BIONATUJ,�r
......... . . ...
'BUILDI
NO DEPARTMENT Applicant Fill
Inside Ileavy Lines JUS ADDREHS
PERMIT
APPLICATION (WC
-
NAME (OR NAME OF BUSINESS)
5 SETBACK
SIDE YARD SETBACK STREET SETBACK REA.R YARD
MAILING ADDRINUts
HE ZONE LOT AREA VACANT
YES 1`1 NO
CITY 'UMOBER
HEIGHT AREA VARIANON
NAME
VED
ADDRESS tiTILEET It/W
a PROPERTY
EXISTING STREET R/W ............ FT- DEFICIENCY. THI
TELEPH E NUMBER 0.
CITY CO?dP. PLAN ST. R/W ............ FT- .......... FT.
REMARKS
NAME
�15CED _13Y�
r e
ADDRESS
eAl METER SIZE SERVICE SIZE CLEARANCE CHECKED By
61T PHONE NUR —BM=
0
STATE LICENSE NUMBER I LICENSE NUMBER
TYPE CONNECTION VERIFIED By
Legal Description of Property (Show Below or Attach Four Copies)
PERO. TEST
Z
0 REMARKS 2
REET IMPROVED
YPE OF CONSTRUCTI—ON ST
FIRE ZONE T
E3.YES [3-NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP.
0 YES NO
0,
PLAN CHECKED BY
GAS
RESIDENTIAL
LINE REMARKS
NEW
-RES SIGN
ADD RETAINING
WAM'
El - i)Emoxasn El
PENCE
ALTER EXCAVATE
OR FILL
.......... x .......... Ft.)
El ORE -MOVE SWIM
REPAIR - �:�
INSP. POOL
NUMBER OF STORIES rquA2"Mn ur 1
DWELLING
UNITS
NATURE 'WORK TO HE DONE
Valuation Fee, Receipt No.'
t . cAl
Z
Pion Check No ............. .......
PROPOSED USE 'v
BUILDING
PLUMBING
PLOT P"N (Indicate j3uliding setoac", uum,mb street$)
HEAT & GAS
LINE
PENCE 0
SIGN
" J"�
RETAINING WALL
/�o D SWIMMING POOL
DEMOLITION
...JV .......
----------- d
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAT, AMOUNT DUE
I hereby acknowledge that I have read this application; that the ill- 4,(00,
that I am the owner. or the duly author -
formation given is correct: and
and state laws regu-
zed agent of the owner. I agree to comply with city A:TTENTION APPLICATION APPROVAL
lating COUstrUction: ejud In'doing the work authorized thereby. no.person
will be I employed In vl0I&tl0n_0f the Labor Code of the.State of Washington THIS PERMT This application is not a permit
RIZES
Workmeno Compensation Insurance. AUTHO signed by the Building official or his Dep,
relating to ONLY THE
and fees are paid, and receipt Be
NOTE: Permit Limit One Yedr (Except DEMOLITIONS Which AVORK NOTED uty;
shall be completed in ninety days; DIOVED-IN BUILiANGS shall be com- Imowledged in space provided.
pleted in etc months.) N SIGNED INSPECTION DIRECT 'S.BIGNA
S U
ONATURE (0 ER DEPARTMENT
27e
CITY OF —5—ATE
b-10 48
]EDMONDS
NOTE: APPlicant Subject to Plan Check Fee
Iln 6-1107
t covers work to be done on Private property ONLY.
This bile domain (curb$, sidewalks, driveways, INSPECTOR
e
A struction on the Pu arste perminsion.
ny uses, etc.) will require sep