670157.pdf4
POSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT NUMBER 670157
Applicant Fill
PERMIT APPLICATION inside Heavy Lines JOB
NAME (�7 OF BUSINESS)
/ -1 - M SIDE YARD SETBACK STREET SETBACK AUAR YARD blWrj,�CR
/"
a ADDRES
/V USE ZONE LOT AREA VAVAV,17 13"ai
TE-LEPRONE NUMBER YES 0 NO
-0 HEIGHT BUILDING AREA VARITNCE NUM13ER ;k
I NAME
PLOT PLAN APPROVED
ADDRESS
STREET R/W
CITY HONE NUMBER EN38TING STREET R/W ........ ... FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. ......... 3".
REMARKS
NAME
CHECKED BY Z
ADDRESS N
CITY TELEPHONE NUMBER METER SIZE I SERVICE SIZE I CLEARANCE CHECKED BY
REMARKS
STATE LICENRE NUMBER I C! LICENSE NUA&BER
Z
Q
I
or Attach Four Copies) E I I I i I
ZONE TYPE OF CONSTRUCTION STRr T IMPROVED
[] YES 13 NO
[3 YES [] NO
NEW RESIDENTIA: REMARKS
0 ADD NON -REBID . NTjIAL !IG;N
RETAINING
DEMOLISH WALL
PENCE
0 ALTER EXCAVATE
OR FILL
REPAIR PRE -MOVE swim
El INSP. POOL
NUM13ER OF STORIES7 NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Valuation Fee Receipt No.
Plan Check No ................ . ...
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks. abutting streets) PLUMBING
HEAT & GAS LINE
PENCE 0 0
10
t SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the In. TOTAL AMOUNT DVE 0
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 constmction; 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 This application is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE signed by the Building Official or his Dep-
NOTE: Permit Limit One Your (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
shan be completed In ninety days; MOVED -IN BUILDINGS shall be com. knowledged in space provided.
pleted In six months.)
MGN (0 WV R AGENT) DATE SIGNED INSPECTION
TA DEPARTMENT D C PC 8 SI(G1;N;,03,TPRE
'PER 0
CITY OF
DATE
EDIVIONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1101
This Permit coven work to be done an private property ONLY.
Any construction an the public domain (curbs, sidewalks, drivinvays,
FILE
marquees, etc.) will require separate permission.
. . - . 1� __ , " - , � . - __ - , � - . I . I ... ... I . I - .. I ... � - I � ....
APPLICATION -BUILDING PERMIT
"OF EDMONDS Building Department
A",
Permit limit, one year
COD
__ NATION is hereby made for a permit to construct the following work, in accordance with the a in
and specifications. Two sets are submitted herewith for approval.
Off'st.
alter
_�� ............... ............................................. Parking ......................
g
repair ............
...............
,'I, "F,
S'7- 5 U0
se zone... Fire zone ...........................
.............. U
................................ Const. type ................
01WIFY
............ Blk ........................ Addn ......................................
....... ....... J ------ '...W ....... �a
.... Lot .. ...
........................
'frontage ........................................ Area ........................................... Septic tank . .............................
r. side ......... ......... rear...,// ...............
set f t . ...... ................... .................... 1. side .....................
_Z/ ... ..............
0../�e6
ner. .. ............... ......... .................... Address. ..... . . ........... 124 ........ .... .. Tel. N : ..................
I I ti, I
Ider................................................................... Address .................................................... Tel. No .............................
Plans by .............
Remarks ................
............................ Address .................................................... Tel. No ..................
This permit covers work to be done
.............. (m--prl-vat-e ... propei%ty .. ONLY-; .............................................. .......
Any construc�_-ion on the public domain
............... ... maxqueea ................ .........
atc.) will require �qparate perTiss
The above is a correct statement, an agree to comp y W151011 applicable Codes and State laws regulating this
work.
Signed Owner/Agent... ..... (
-/Ii . &z . . ..... .............
PERMIT for the aborve work is hereby approved, subject to the above condition% andtDcompliance with the ap-
proved plans and specifications, and Building Department notations thereon.
................. Permit fee. ..... ��-/ ................ Recd. by ..... ... .. ... .. .. .. ... ....
Valuation ............ ..... ....
...........
...........
....... .....
Building Department, By ............................................. 6_74N - — ------- Date ........ z:g .... 6z . ..... . ......
This Permit does not cover Plumbing. Sewer or Electrical installations.
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