680277.pdfV
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BUILDING DEPARTMENT Applicant Mn
PERMIT APPLICATION Inside Heavy unes
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CITY
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ADDRESS
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STATEWCENSE NUMBER
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Legal Description Of Property (811C
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or Att
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PERMIT
NUMBER
'ARD SETBAC IMTSACK REAR YAnJJ OWNS
.201 /45�1
LOT AREA VACANT SITE
R:13 13 NO
[1EIGHT JJU&UUAAU �� k
I t4sS 13
FLOT —PLAN APPROVED
STREET BIW
EXISTING STREET R/W -3.L-.--FT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W JO ... 3".
REMARKS
Drivewav alopes not to exceed those
on
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30
R
[3 YES 13 NO
NEW toRESIDENT GAS
13 LINZ
TIAL
E] NON-REWDE SIGN
ElRETAINING
DDEMOLISH WALL
ALTER EXCAVATE PENCE
0 OR FILL El ( ........ . x .......... Ftt
0 YES U"KP
PLAN CHECKED 33Y
REMARKS
REPAIR PRE -MOVE SWIM
El INSP. POOL
rquhu� OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
It ato S tj knr_
Plan Check No ................ ...
valuation
Fee
-Receipt No.
ra &i c
PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indicate Building setbacks. abutting streets)
HEAT & GAS LINE
P7.
01
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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I hereby acknowledge that I have read this application; that the In-
formation given is correct; and that I am the ovmer, or the duly author-
ized agent of the owner. I agree to comply with City and state laws regu-
laUng 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 Umit One Your (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUIT NOS shall be corn-
pleted In six months.)
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
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.
Olt
SIGgT WRER —OR AGENT)
DATE SIGIED
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CITY OF
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit coven work to be done on privaU property ON]6y-
Any construction on the public domain (CCrb5# 2IdaW&lk@p drIVOWSYSt
noarquees, etc.) will require separate pern-Assion.
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$CATION 1�_ SUILOING PIMMIT
1 0 , MONDS Building Department
A p p 1. N o. .4 P-: 51 . ....
Permit llmit� one year
I n I ON is hereby made for a permit to construct the following work, in accordance with the accom,
M and specifications. Two sets are submitted herewith for approval.
� I . — Off'st.
alter
.... Parking ......................
r6pair ...... . .............. ..
..................
i:2
I I r:� Fire zone .........
............... Const. type ................................
se zone ..... . ....... ...... ...................
/a- ........................
Blk ........................
Addn ......................................
....................................... . Area ............................................ Septic tank ..............................
ietbacks— front ............................ r. side ............................. L side .............................. rear ...............................
Na ...........
me ...... ... Address ..... J.� .............
ON V? .. .........
. ............ ..... ............. Igo .............................
V Builder Address ...........
.................
....................................................... Address .................................................... Tel. No ............
Plans by ..........
.... ;AN"
Remarks.................................... ......... ...... ......
.................... ........................... ....................... ..................
...............................................................................................
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work.
..............
Signed Owner/A2.� ate�.
.... .. Ad ........ .. 1.4
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with me ap,
proved plans and specifications, and Building Department notations thereon.
........... Recd. by..... .... ................. ...
Valuation ............. �6 ........... Perni t fee .......... C�� ... ....... ...........
......................... ; ..............
Building Department, . .......... Date ..........
............ ....... I ...............
NOTE -- This permit does not cover plumbing, sewer, or electrical installations, nor does it permit any work to be
done in the Right of Way a -teas. Driveways and walkways must be planned to meet the official grades of streets
and alleys, and plans for future sidewalk development-
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