670426.pdfNUMBER
aintuf_% nCDADTM9MT -F0—WrE5__0_N KROLL MAP NO.: PERMIT 670426-o
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PERMIT APPLICATION
Nhm (OR NAME or BUSINESS)
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10
MAILING ADDRESS
64)19 e
Applicant Flu
Inside Heavy Lines
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0
Z
USE ZONE LOT AREA VACANT SITE E
1 [3 YES [3 NO
I IT"T."Tmn Awvl� I VAI�Um
RESIDENTIAL
GAS
LINE
F] NEW
J
NON-RESIDENTIAL
SIGN
RETAINING
DEMOLISH
WALL
ALTER
EXCAVATE
OR FILL
wx ..... (,?. Ft.)
REPAIR
PRE -MOVE
INSP.
swim
POOL
ES
NUMBER or
DWELLING
UNITS
EXISTING STREET R/W ............ FT -
COUP. PLAN ST. R/W ............ FT.
13 YES 13 NO
Plan Check No .............
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT 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-
ized agent of the owner. I agree to comply with city and state laws regu-
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's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; HOVED-IN BUILDINGS shall be com-
pleted In six months.)
— TA_T_UI�E_R AGENTt DATE SIGNED
"JOWNER 0
INSPECTION
DEPARTMENT
7
CITY OF
EDMONDS
NOTE: Applicant Stibject to Plan Check Fee
Pit 0-1107
This permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drive%vays,
m.arquees, etc.) will require separate permission.
DEFICIENCY THIS PROPERTY
............ FT'
CKED BY
IQ
0 YES [3 No
Valuation I Fee I Receipt No.
00 1
1 0 0 1(3,T q 6
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-
Imowledged in space provided.
DATE
FILE
4
APPIJGATIDN BUILDING PERMIT Appl. No.
CITY OF EDMONDS Building Department Permit
APPUCATION 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.
Off -St.
Wor� C�e al 0
w ter ............................................. Parking ......................
V repair . . .......... . ..........................
(2
Fire zone
Occupancy ............ ... ........ ......
oEnsjype. ............................... Use zoneA_'..0 ..............
Addn...
17
t .....
Addressl :n .. ............. .......... �7 A-
I
,Vea .... tank. .......
Lot frontage ........................................ . ... .... ..tr septic
_A_ __
Bldg. setba4s front ..... .... ....... r. side ............................. 1. side .............................. rear .... ............
Owner el. N
6;46w�..� .. �em..
...............
..........
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.
............................... .................. . ...
Signed Owner/Agent ... .. ....................................... Addr .............. Date.
............ ..
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.
Valuatim ........... 46 ... V��J� ............ Permit fee ....... 3Zi! ......... Recd. b� ....... *. ........ ...... "!��
-e ...............................
.... Date...
Building �Departnient, ... . . ... ..... .. .. ... .... -Yo ... 6.z
... .. ........
tit any work to be
NOTE — This permit does not cover plumbing, sewer, or electrical installations, nor does it pern it f�treets
done in the Right of Way areas. Driveways and walkways must be planned to meet the official 71g7rades of streets
and alleys, and plans for future sidewalk development-