680002.pdfDING DEPARTMENT Applicant Fin
WIT APPLICATION Inside Heavy Lines
OR NAME OF BUSINESS)
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TELEPHONE NUMBER
PRESS
TELEPHONE NUMBER
STATE LICENSE NUMBER
CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four copies)
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ElNEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
SIGN
DEMOLISH
RETAINING
WALL
EXCAVATE
FEN4gE
ALTER
OR FILL
U7y--x--0 Ft.)
El REPAIR PRE -MOVE
El
...
SWIM
INSP.
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
5.�
13 YES
[3 NO
STREET R/W .... ....... IT. DEFICIENCY THIS PROPERTY
jj YES 13 NO
PLAN CHECKED BY
Plan Check No ......... .. ........
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
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-
formation given In correct; and that I am the owner, or the duly author-
Ited 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 PERbnT
relating to Workmenlo Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE31OLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be oom.
pleted in six months.)
SIGN (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit coven work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, ate.) will require separate permission.
I
FA
Ej YES [3 NO
Fee
M
I CD - 0 IV 14 M 4
APPLICATION APPROVAL
This application is not a pernilt 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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APPLICAQd&A & WORK PERMIV Application No. 1;,A-17
CITY OF EDMONDS Building Department Permit Limit, One Year
APPLICATION is hereby made for a permit to construct the following work, in accordance with the accompanying plans
and specifications:
,,, , ./ ��k
... I ............................. �?� Ground Area ................................... No. Stories ............
... . ...... . ...
..........
WORK — New/Addn.
Hel-'ht ...
PlansSubmitted .................... ......................
Po
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............................ Const. ITpe ............ . .......................... ................. . .
... ... 7 -Fire e . . .........
.... ........ �... Use Zone
�r /"' �Fe '1� . ..... .....................
Block ......... 6_1'r .........
......... Sewerage ......................... . .........
Recorded Lot ... ... Add'n..iw .............
Lot Arm ............... . ...................... Width ............................ Min. Bldg. Setbacks, Front and Rear ............................... Sides ....... . .....................
"A Phone ................................
Ownerl?/,O.VC�Z .... .......... . .............................. Address .........................
Plansby ...................... . .............. . ................................................... Address ....................................... . .............. ................ Phone ... . .................. . .......
... Address .................................................... . ................. Phone ................ . ..............
Bldg. by ........ . .... . .. . ... . ................................... I ......................... . .
Plbg. by ............................. . ........................................ . .................. Address .............................. . ........................................ Phone ....... . ... . ..................
Heatingby .............................. . ................................ . ..................... Address ......................................... I .............................. Phone.; .............................
Elect. by ............................................................................................ Address ...................... �; .............. I .................................. Phone ................................
1_10 411. 11 ±��,7 �- I
......... jx�e_ . zoz- . e--
Remarks........ I ...................................................... ;� ............ ............... .......... ..... :-:/
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The above Is7a correct
and I agree to comply with all
SE
Codes and State Laws regulating the work.
Signed: Owner/Agent .................................................................... Address ............................................................................ Date ............................
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with. the approved plans
and specifications and Building Department notations thereon.
VALUATION PERMT FEES
Bldg. $ ........................................
...........................
APPROVED:
Date ......... e"�:- W* .... . 7 .....................
BUILDING DEPART;4ENT
Plbg. .... $ ........................................
Heat.... $ ........................................
Elect. . . - - $ ........................................
Others$ ........................................
3TALFEE $ ........................................ .
InspeltioZishall be/covered before inspection and approval.
NOTES: No work requiring Building 4elpartment"or City Engiifors
Twenty-four (24) hour notice requested. Contact the City Engineer prior-fo construction of all site utilities, such as
curbs, paving, driveways, sewer, water and street connections.