680364.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
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AppReant FIH
S
Inside Heavy Unle8
POSTED ON KROLL MAP NO-:
PERMIT
NUMBER
680364
JOB 78...
81 DE YARD SETBACK
SETBACK
REAR YARD BEYEBAC X
USE
J�
VACANT SITE
I [] YES E3 NO
XF—HONE NUMBER
I BUILDING AJURA
I VARIANCE NUMBER
161
HONE NUMBER
HONE NUPBER
0 -(, I -L-L
NEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
SIGN
RETAINING
WALL
ALTER
DEMOLISH
EXCAVATE
OR FILL
FZNQJn..a.Ft.)
ZAVA.
.
REPAIR
PRE -MOVE
INSP.
swim
POOL
DWELLING
UNITS
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I hereby acknowledge that I have read Utts application; that the In-
formallon given in correct; and Mat I am the owner, or the duly author-
ized agent of the owner. I agree to comply With city and state laws regu-
lating construction; mid In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workmens Compensation IMMUMnes.
NOTE: Permit Limit One Your (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done an Private Property ONLY.
Any conshim4lon an the public domain (cube, sidewalks, driveways,
marquees, eta.) Will require separate Permission -
____ -1 -
EXISTING STREET R/W .......... JPT- DEFICIENCY TMIS PROPERTY
COUP. PLAN ST. RIW ............ Fr. ........ ... FT.
0 YES
[3 YES [3 NO
Plan Check No ............ ... ...
[01=1
NO.
PLUMBING
HEAT & GAS LINE
FENCE
on
SIGN 1�p
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
'a 00
ATTENWON APPLICATION APPROVAI,,/
TWO PERMIT This application is not a permit until
AUTHORIZES
ONLY THE signed by the Building official or his Dep-
WORK NOTED uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
INSPECTION
CITY OF
EDMONDS
FR 6-1101
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DATE 4r-
2
- -
APPLICATI( A & WORK PERMIT
Application No. -;�:Ot6 ................ —3
CITY OF EDMONDS Building Department Permit Limit, one Year
ATION is lie t ct the following workp in accordance with the accompanying plans
APPLIC reby for a permit to cone ru
And.1specifications:
No. Stories ............
W01WNew/Addn . .................................................... .......... Ground Area ..................................
... ..... Height .......................
PlansSubmitted .......................................................................................................... Const. Type ............
............ use Zone.e:� Fire Zone ....................
LOCATION — Address,"a-3 .. .............................................................. i .....
Lake Ballinger Land Co.'s ubdivision 1. less North 90.18 as
Recorded Lot .... f ......... BloclL. OL19.9_1P.5,9 ... W....11"arage .... ...............................
.................
Lot Area ... S,-42 .. . ............... Width ........................... Min. Bldg. Setbacks, Front and Rear ................................ Sides .............
Owner ... .................. ............
....... ...... ................ Address...-:P .... ....... —;' Phon Z.11f:�-o
Address............... ......................... Phone ....................... . .......
Plans by ................. . .......... . ...........................................................
................................
ddress. ....................................................................... Phone ........................ .......
Bldg. by ........................................................................................... A
Address........................................................... . ........... Phone ................................
.................... .......... .............................
P1bg. by ......
Heatingby ....................................................................................... Address ........................................................................ Phone ................................
Elect. by ...................... .................................................................... Address ........................................................................ Phone ................................
....................................
Remarks ......................................................................................................................................................... . ...............................
. ...........................................................................................
.....................................................................................................................................................
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...............................................................................................................................
..............................................................................................................
The above is a correct statement and I agree to comply with all applicable Codes and State Laws regulating the work.
11-2
Signed: Ownerl.& ".dreas ............................................................................ Date ......... .............
PERMIT and to compliance with the approved plans
for the above work Is hereby approved, subject to the above conditions,
and specifications and Building Department notations thereon.
PERNE[T FEES
VALUATION
Bldg. $ ........................................
.... ......................
Plbg . .... $ ........... vp�E,....
Heat.... $ ........................................
APPROVED:
Elect. ........................................
Date ....... .... ....................................
BUILDING DEPARTMENT Others ... $ ............................ 6
WM.,. Herbert.,,
By ............................... TOTAL FEE $ .......... ..........
................
al.
NOTES: No work requiring Buil g Department or City Engineer's inspection shall be covered before inspection and approv
Twenty-four (24) hour notice requested. Contact the City Engineer prior to construction of all site utilities, such as
curbs, paving, driveways, sewer, water and street connections.
74�
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i ng Buil g Dep ent or Cit