670386.pdfIt
BUILDING DEPARTMENT Applicant FM
Inside Heavy l[Anes
PERMIT APPLICATION
-MMRG ADDRESS -JF
MfTELEPHONE NUMBER
L, PIZ 9— L)__L_Z �_ I
I=
or
NEW
EIRESIDENTIAL
i
GAS
LINE
El--
El
NON-RESIDENTIAL
SICK
RETAINING
DDEMOLISH
WALL
DALTER
f--j
EXCAVATE
OR FILL
D
FENCE
( x Ft.)
........ . ..........
REPAIR
D
PRE -MOVE
INSP.
F1
SWIM
POOL
DWELLING
UNITS
)N XROLL MAP NO.: PERMIT
NUMBER
?.EBB
b /, � /7-27 n
P D S ffB7A c _K
I STREET SETBACK
670386
[3 YES Cl NO
EXISTING STREET R/W ........... IFT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT -
[j YES [3 NO
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
RETAINING WALL
SWIM NO 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 Is correct; and that I am the owner, or the duly author-
aa�:*
ized agent of the owner. I agree to comply with city and state lawn regu-
ATTENTION
latinc construction; and in doing the work authorized thereby, no person
h I
ng
will be employed in violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workman's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE52OLITIONS w-hlch
I j
ONLY TM
WORK NOTED
om_
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
IS
1IONATURE (OWNERAR AGEN DATE SIGNED
N
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This paro-at coven work to be done on Private property ONLY -
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation
2:
13 YES 0 NO
Fee
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-
Itnowledged in space provided.
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I
& BUILDING PERMIT Appl. No.
APPLICAT07
:EDMONDS Bulldog Department Permit limit, one year
is hereby made for a permit to construct the following work, in accordance with the aceom,
.00 ications. Two sets are submitted herewith for approval.
r 1:2 Off -St.
air..................... I .................................................................. Parking ...................... . ..
.............. Const. type ............................... Use zone .... ..... Fire zone ...........................
'Addn .......................................
................. Lot.Z.. �. .......
............................................
...........
............. Area ....... ea.. O..e.f ............... Septic tank .............
r
i' front ........ r. side ....... ............. 1. side ..... ................ rear ...... 714.1 .............
..... .................................... Address ................................... Tel. No.e&.Af� 7.
.. . ... ...
... ............. Address. ..... Tel. No.A::��7.
........................................................ Address ................................................... Tel. No .............................
.................................................................................................................................................................................
ks.
cable Codes and State laws regulating this
Ile above is a correct statement, and I agree to comply with all appli
O-V
work.
SignedOwner/Agent .......................................................... ... Address ............................................ Date/n ..... . ...
PERMIT for the above work is hereby approved, subject tDthe above conditions, and to compliance with the ap,
proved plans and specifications, and Building Department notations thereon.
5
0-0
Valuation .......... .......................... Permit fee ............. lk .............. Recd. by.. f .....
BuildingDepartment, By ...................................................... ................... Date ............ z ....... �z . .........................................
INSPECTION RECORD
Fdn, OK ............................................ Frame, OK .................................................... Final, OK .......................................
This Pennit does not cover PlurAbing, Sewer or Electrical installations.
BUILDING PERMIT Appl. No . ....................... . ......
Building Department Permit limit, one year
to construct the following work, in accordance with the accom-
.,1#,uWcJqr, a permit
0
. "' 0 isets submitted herewith for approval.
,TW are
Off'st.
oe..... . .. . ...........
..................................... Parking
Z... .. .................. .......................................
... Use zone ....... ................ Fire zone ...........................
.type . . ..........................
... Addn ......................... ............
Lot ....................... Blk .....................
... ........ ..
............ ........................................... Septic tank .........................................................
...... r. side ............................. 1. side ............................. rear ...............................
ddress. ............ XP e� Tel. No
............... Tel. No .............................
. ....................... Address. ....................................
........ Address ................................................... Tel. No .............................
. .................................................
.................................................................................................
plicable Codes and State laws regulating this
Tv,
t statement, and I agree to comply with all ap
e e is a correC
ww or
.........
Date.A.
.........
SignedOwner/Agent .. . ... ................................................... Address ............................................
the ap,
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with
proved plans and specifications, and Building Department notations thereon
itfee .......... ........ Recd. by....A-1f---Z/? ..... . ..............
Valuation ......... ......................... Perm ......
..............
................. Date .................. ..
...... ..........................
Building Department, By ...................................................... ..
INSPECTION RECORD
Fdn, OK ............................................. Frame, OK .................................................... Final, OK .......................................
This Permit does not cover Plumbing, Sewer or Electrical installations.