680221.pdfN
BUILDING DEPARTMENT
U D
PERMIT APPLICATION
P R
Applicant FM
Inside Heavy Lines
POSTED ON KROLL MAP NO.: PERMIT 53022T
� 115-� NUMBER
JE - , IJ — -"*to aA
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JOB ADDRESS v sc jr F
SIDE YARD SETBACK STREET SETBACK REAR 1JLK0 bb;711,
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1A /Y 1 —
0
r NAME (OR NAME OF,40USINEdS)
7
IL AD
MAILING ADDRESS
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7 Id d fj'- y
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USE zorm
LOTAREA
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VACANT SITE
0 No
CITY
FX44,11 Ott �s
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TELEPHONE NUMBER
3,5� A4
BUILDING AREA
-3
VARIANUM muMBE:
A
NAME
/Vt 1>
PLOT PLAN APP40VED
ADDRESS
/7�/ �) Z, f L
STREM H/W -
EXISTING STREET R/W DEFICIENCY THIS PROPERTY
r ..... 0 .. FT.
COMP. PLAN ST. R/W .0, 'T,
CITY
TIOLEPHUNN-NUMBER
3
a
4 m e-
TELEPHONE N�
rATE LICENSE NUMBER
CITY LICENSE NUMBER
Dged Description of Property (Show Below or Attac our lopics)
ej tAAC /0,/v
EZRESIDENTIAL
NEW
ENTI
1:1 NON-RESID AL
0 DEMOLISH
F-1 ALTER EXCAVATE
0 OR FILL
REPAIR PRE -MOVE
1:1 INSP.
El
El
GAS
LINE
SIGN
RETAINING
WALL
PENCE
(. ......... x .......... Ft')
swim
POOL
IUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
FATURE OF WORK TO 13E DONE
AIC-W 00"3�kldC4(�xj
indicated on Standard Drawing #103.
CHECKED B'.
Lt L
METER IZE I SERVICE SIZE CLEARANCE
REMARKS I
TYPE CONNECTION VEV,7D BY
PERC.TEST Pn T NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREE
1 0 YES
SPEMAL INSPECT IRED OCCUPANCY GROUP
[3 YES : 1 1d__1
Plan Check No ................ . ...
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets) PLUMBING
HEAT & GAB LINE
FENCE
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-
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 PEIMIIT
relating to Workman's Compensation Insurance. AUTHORIZES
ONLY TIIIE
NOTE: Permit Limit One Year (Except DE51OLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be eom-
pleted In nix months.)
;1017RE (OWNER OR A DATE SIGNED INSPECTION
17GE DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee Fn 6-1107
This Permit covcrg work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
- This permit issued subject
,t plan being submitted.
A. Ellixi,
A
Valuation I Fee
z
FUUMM27146M.
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.
FILE
45� � .
I
Floor Load signs -in place (per Sec. 23o8 U.B.C.) —Capacity signs _posted (per Sec. 3301 (i) U.B.C.)
Floor load and roon) capacity signs, wben required, ninst remain posted at all thnes.
THE TRI—PLEX HAS BEEN INSPECTED AND APPROVED AS COMPLYING WITH
PROVISIONS OF THE EDMONDS BUILDING CODE AND WITH UNIFORM BUILDING CODES.
Issued this 19th -.-day of MAY 9 69
CHIEF BUILDING OFFICIAL By . 0
shall be main -
This certificate shall be posted In a conspicuous public area and shall not be remove , mutilated or obscured and
talned in legible condition at all times. Any change of occupancy requires a new certificate.
R
APPLICATION BUILDING PERMIT Appl. No. ...... �9 ........
CITY OF EDMONDS Building Department Permit limit, one yeark
APPLICATION is hereby made for a permit to construct the following work, in accordance with the accom-
panying plans and specifications. Two scts are submitted herewith for approval.
new
alter Off -St.
Workaddn repair ....... ............... 7 ............ :r ................... ............... Parking ..... . .. . ...........
Oc ....... gonst. ty e ....... Use zone ..... ..... Fire zone ...........................
cynq� -,, ................ - Lyn
Address...-.9i. Lo ....... . ............... Blk ..................... Addn ............... . .....................
t
Lotfrontage ....................................... Area ........................................... Septic tank ..... . . V ...
Bldg. set,backs front ............................ r. side ............................. 1. side ............................. rear ................................
...................
............
...................
Owne ............. d ....
14X
Builder................................... ...... t . . ..................... Address .................................................... Tel. No .......................... . .
Plansby .................................................................. Address ........... ............. .................. Tel. No ................ . ...... . ...
Remarks.. K . ................................................................................................
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work.
tSigned Owner/Agen ............................................ Date ........ .........
with
PERMIT for the above work is hereby approved, subject to the above conditions, and to compHance.x
proved plans and specifications, and Building Department notations thereon.
Valuation ......... . ........... Permit fee .. :5.f ............... Recd. by .... J
Building Department, By ............................... . ................... Date..t;� ... . ... gii�5n .........................
INSPECTION RECORD
Fdn, OK ............................................. Frame, OK ..................................................... Final, OK .......................................
This Permit does not cover Plumbing, Sewer or Electrical installations.
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