680175.pdfPOSTED ON KROLL MAP NO-: PERMIT 680175
BUILDING DEPARTMENT Applicant 011 NUMBER
PERMITAPPLICATION Inside Heavy Lines JOB ADDRESS C��a
NAME (OR NAME; OF BUSINESS)
40 0
SIDE YA D SETBACK STREET SETBACK REAR Y&D SETBACK
4
MAILING ADDRE1313
U13M ZONE LOT AREA VACMl SITE
TELEPHONE NUMBER MYE"I N
CITY I
A=�) / 0/ ? 6 — t'l, W/ r W/ HEIGHT BUILDING AREA CEI�UMJSER P"
-/— /
NAME
PL40T PLAN APPROVED
ABID—RESS
STREET R/W
cy THIS PROPERTY
CITY TELEPHONE NUMBER EXISTING STREET R/W ............ FT. DEFICIEN
COMP. PLAN ST. R/W ............ FT- ... ........
REMARKS
NAME
WAIew
ADDRESS Z
CHECKED BY
TELEPHONE NUM—BER
CITY
Z ER SIZE SERVICE SIZE ICLEARANCE I CHECKED BY
I MET
13TATE LICENSE NUMBER CITY LICENSE NUMBER
REMARKS
Legal DescripLl of Property (Show Below or Attach Four Copies)
7- C VERIFIED BY
TYPE CONNECTION
Z
PERC. TEST PERMIT NUMBER
REMARKS
ro
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
[] YES [3 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
B_,�ESIDENTIAL GAS F]YEB [3 NO
D NE LINE PLAN CHECKED BY
W
NC SIGN
&'ADD RETAINING REMARKS
DEMOTJSH WALL
ALTER EXCAVATE PENCE
OR FILL ( ........ . x .......... Ft.)
PRE -MOVE SWIM
REPAIR INSP. POOL
NUMBER OF
DWELLING
UNITS
Fee
No.
Plan Check No ..............
PROPOSED USE
BUILDING
//0-00
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
RETAINING WALT
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
0
I hereby acknowledge that I have read this application; that the In-
forntation 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-
ATTE1%MON
APPLICATION APPROVAL
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
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or lils Dep-
h
NOTE: Permit 11mit One Year (Except DEMOLITIONS whicj
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com.
latowledged in space provided.
pleted ly)ix months.)
DATE SIGNED
INSPECTION
DEPARTMENT
DVOR SIGN�k�T�
CITY OF
EDMONDS
DATIT
NOTE: Applicant Subject to Plan Check Fee
Cf
PR 6-1107
his Permit covers work to be done an private property ONLY.
Any oonstruction on the public domain (curbs, sidewalks, driveways,
Fn an
marquees, etc.) will require separate permission.
HIMER
a,
7i
I
kAPPUCATION
hY OF EDMONDS
�.newo
4ddn
4ress ......
10 V
Bldg. set,backs
BUILDING PERMIT
Building Department
Appl. No . ....... . ...... . .
Permit limit, one year
4 is hereby made for a permit to construct the following work, in accordance with the accom,
d specifications. Two sets are submitted herewith for approval.
alter ) Off'st.
..............
repair ........................ ...... ....................................... Parking ......... . ...........
Const. type ................................ Use zone ... e=1 ........... Fire zone ...........
ze-k 4�.. ....... : Lot .......... ..... Blk ........................ AdciK��r� I
W, ' * .... ........ / .... : .. ................
........ Area ........................................... Septic tank ....... - I
... ( zce ....................... * ................
r side .................. 7 .. 1. side ...... //../ ............. rear .........
... ...... ......
Tel. .. gl-79 .. :'!-4
....................... Address.. ..Z�!?� ............................ ...... .......
............................ Address .................................................... Tel. No .............................
I
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.
, Yx
Address ............................................ Date2z:�Z'e.
Signed Owner/Agent.-01.4. . .. . ........
V-10 ..... .......
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.
............ . ......... . ....
Valuation ...... ls..Ozino ............ Permit* fee ..... �.50 ................ Recd. by.2 L�
Building Department, By ............ le� ...... ................. ................... Date ..... .......................
INSPECTION RECORD
Fdn, OK ............................................ Frame, OK
Final, OK .......................................
This Permit does not cover Plumbing, Sewer or Electrical installations.
i
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