670563.pdfrLo -
V
UILDING DEPARTMEN
PERMIT APPLICATION
(Vt 9=*-
1 W.O�: 1�
ApplIcant MR
inside Reavy Lines
T&M-MONE NUMBEE
<Y& i'o - -1 al
or
PEPM3T
NUMBIM 670563
,C;L > 7 0 -5- -
USE ZOIITE LOT AREA VACANT SITE
1 1 13 YES C3 NO
I —.-- I UTM."Ymn I vARLANCE. NUMBER
NEW
El RESIDENTIA
E'
AS
2IN I E
NON -RESIDE TIAL
SIGN
RETAnTING
El
WALL
ALTER
DEMOLISH
EXCAVATE
OR FILL
PENCE
( x Ft.)
........ . ..........
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF
DWELLING
UNITS
;;�_8!i;NG_1 S'='EET R/W ........... XT. DEFIC=vcy TMS PROPERTY a
COMP. PLAN ST. R/W ............ .......
REMARKS
CKED BY 0
YES [3 NO
Plan Check No ........
BUILDING
PLUMBING &L"
HEAT & GAS LINE
PENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
form&Uon given is correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state laws regu- ATTENTILON
I&Ung construction; and in doing the work authorized thereby. no Person
will be employed In violation of the Labor Code of the State of Washington TIUS PERMIT
relating to Workmen's Compensation Insurance. AUTTIORIZES
ONLY TH[E
NOTE: Permit Limit One Your (EXcept DEMOLITIONS which WORK NOTED
shail be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months-) DATE S,IG7ND INSPECTION
DEPARTMENT
J CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee pit 6-1107
This permit coven work to be done on private property ONLY.
Any oongraction on the Politic domain (curbs, sidewalks, driveways,
marquees, etc.) Will require separate permission.
I
0 YES 0 NO
Fee
'No. I
I ;L"0-0 ('&Sal
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-
knowledged in space provided.
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P40ATION 1�'.SUILBMG "Muff C Appl. No . ......
60. liOMONDS Building Department Permit limit, one year
, CMPH
made for a permit to construct the following work, in accordance with the accom,
Two sets are submitted herewith for approval.
Off -St.
ter,
............. .
.............................
.......... I . ......................................................... Parking .........
...... Const. type ............................... Use zone ...... ........ Fire zone ............................
...........
AIL
094-sa '? ......... Blk ........ ............. Addn ... 2
�2 ................... T-0t: ............
IC....................................... Area, ........................................ Septic tank ........................................................
1 7
front........................... r. side ............................. 1. side .............................. rear ...............................
el. No..4 . ...................
.................................................
........ Address. ..... .............................................. Tel. No .............................
.... 4
ui"Id .. . ............. . ...........
er..., ...................
Address.................................................... Tel. No ..................... .......
Rimaiks.................................................................................................................................................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
........... .. ... . .. . . .... .. . . .. . . ... . ... . .. . . .. . . .. . . .
.-The'above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
'Vor
je�
Signed Ow
nerlAgen ........... ..... /:�4�14.�.Address..Ip lg�Wstkl.!eDate...
for the above work is hereby approved, subject to the above conditions, and to compliance with the ap-
notations thereon.
proved plans and specifications, and Building Department
t9�
...... �i . ............ Recd. by .....
Valuation ......... ........................................ Permit fee ...... *'Z"*
Building Department, By ..........................
........... . ................... Date ........... ........................
it tiny work to be
NOTE This permit does not cover Plumbing, sewer, or electrical installations, nor does it perms
done in the Right of Way areas. Driveways and walkways must be planned to meet the official grades of streets
and alleys, and plans for future sidewalk develoPment-
I
0
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