670435.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside HeSVY Lines] ion AD96
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PLAN
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RESIDENTLALL
GAS 14�,
LINE
NEW
,NTL,L
NON-RESIDENTIAL
SIGN
RETAIMNG
WALL
DEMOLISH
ALTER
EXCAVATE
OR FILL
FENCE
( ........ . X . ........ Ft.)
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
-N�tIMBER OF STORIES
NUMBER OF
DWELLING
21
UNITS
D"&)g
Pwa,/ I #on
Q= 6
W7W
1 STREET R/W
PLAN ST. R/W
0
Plan check No ........
BUILDING
pLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
kAMOUNT
DEMOLITION
pRE-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL 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 &=so to comply with city and state laws regu-
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
relating to Workmen's Compensation insurance.
NOTE: permit JJmit One Year (Except DEMOLITIONS which
shoal be complerted In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
7
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on plivata property ONLY.
Any oonstrucilon on the public domain (curbs, sidewalks, driveways.
marque", etc.) will reilutre separate permission.
ATTENTION
TMS PERBUT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
APPLICATION APPROVAL I 'I
This application is not a perlil U;
signed by the Building Official. or hits Detl!l
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
c
RECORD OF INSPECTIONS
)Qor, 4;A et. --4, 7 kt-,' Date Passed
ncOSP7. )&57- WAIL Foundation L�; - J
INSIvir d?6471 f7 I&/'
Plumbing (Partial)
(Rough)
z
Fome
Rmuce & Fud Lines
I
Sub]
Address
Lot .... 7 ........
ZoCAres ......... . ..............
APPLICATIC.1 & WORK PERMIT
CITY OF EDMONDS Building Department
it
Application No.
Permit Limit, One Year
,TION is hereby made for a permit to construct the following work, In accordance with the accompanying Plans
Ground Area. ................................... No. Stories....
)nst. Type ......................................... Height . ........................
v ................ Use Zone .... 1,7/2--vire Zone ........... 5
...........
Sewerage.... ............................... :s:'
WidUL ........................... Min. Bldg. Setbacks, Front and Rear ............................... Sides .............................. �.q I I . . ,
... Phone.4-
.... n.44_'12� .......................... .... .. . ....................
Phone........................ .......
131ans by ............... . ......................................................................... ^,Uii� .................................... .................. ................
......................... Phone ....................... . .......
Bldb Address ............... . ..............................
9. y ...................................................................
......................... Address ........................................................................ Phone ...............................
Plbg. by ................. ........... . ...................................
..................... Phone ................................
Address ...................................................
Hleatin by ......................................................................................
................... Phone....
............................
Elect. by ........................................................................................... Address .................................. ........ .........
Remarks........................................................................................................................................... . ........ . ........................................................................
...................................................
...................................................... .....................................................................
. ..................................................................
. ............................................................
..........................................................................................................................................
..........................................
..... . ............................... . ..........................................................................................................................................................................................................
The above is a correct statement and I agree to comply with all applicable Codes and State Laws regulating the work.
4 N."t, Date.
Signed: Owner/Agent� 44� ........ ................ ......
A&,&I�e ..... Address
and to compliance with the approved plans
PEWIT for the above work is hereby approved, subject to the above conditions,
and specifications and Building Department notations thereon.
VALUATI[ON PEBN[ff FEES
$$ . .............. Bldg. ............
Plbg. $ ........................................
APPROVED: Heat .... $ ........................................
Date............... . .... ... ... .................................... Elect ..... $ ........................................
BUILDIN DEPARTMENT Others ... $ ...................... .................
TOTAL FEE $ ........ .............
By....... . ....... ........
quiring Buildin 4DartWment or City Engineer"s inspection shall be covered before Inspection and approval.
NOTES: No work re 9
Twenty-four (24) hour notice requested. Contact the City Engineer prior to construction of all site utilities, such as
curbs, paving, driveways, sewer, water and street connections.
Z.