680399.pdfI
FM
ApplIcant
Molds Heavy Lines
039
7 -7-
JA67
1
ULWY wjsLEk-BuL4E NUMBER
'5� 5-0 '5-
NAME
"52tcle_ A;1�2zoexl_'-9^1
ADL�RNZH ose /4-9,
ULWY TELEPHONE NUMBER
AEOMOIV�03 1 6 -,49a /
or
NEW
RESIDENTIA
GAS
LINE
I
NON -RESIDE
R
SIGN
ADD
DEM012SH
RETAINING
WALL
ALTER EXCAVATE
OR FILL
FENCE
Ft.)
REPAIR PRE -MOVE
INSP.
.........
SWIM
POOL
rUMBER OF STORIES
NUACBEit OF
DWELLING
UNITS
FATURE OF WORK TO BE DONE
PERMIT
CROLI, MAP NO.:
NUMBER b0UJVV
rOI3 ADDRESS
q I ;:;t J— =I Wj-
31DE YARD BETHILCK
STREET SETBACK
Itzma YARD SETBACK
10 m4s
M a"4)
'k
a A s-' 7)) t"').
I * S'
U&N-00T_
LOT AREA
VACANT BITE
V
I )!�YES E3 NO
ELEIGir
BUILDING AREA
VARIANCM NUMBER
3.5 Th
-r-4,
PLOT PLA RO D
E3X[STDWBT=ET R/W ;5_QXr. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W.6?.Q.FT. ... L.Q_rr.
REMARKS
Drivewav slorles not to exceed those
indicated on Standard Drawintz #103.
13 YES
F
Plan Check No ............
PROPOSED USE
BUILDING
PLUMBING
PLOT PLAN (Indicate BUIldid"tbacka, abutting streets)
HEAT & GAS LINE
PENCE
t
t
SIGN
N
IRETAINING
WALL
SWIM31ING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this applll�zrow. that the in-
formation given In correct; and that I am the owner, or the duty author.
Ized agent of the owner. I agree to comply with City Lad state laws regu.
ATTENWON
latinir 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
relating to WorkmeWs Compensation Insurance.
AUTHORIZES
rmit Limit One Year (Except DEMOLITIONS which
ONLY THE
Olt,
WORK NOTED
shall b o d in ninety days; MOVED-31N BUILDINGS shall be com-
plated months.)
NA (OWNER ORVENT)
DATE SIGNED
INSPECTION
DEPARTMENT
Orry OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PH 6-1107
This renalt OoTers work to be done an private property ONLY.
Any Construction on the public domain (curbsp aldewalket drivewayso
manufts, ate.) win require separate permission.
, _j 00
N
YES 13 NO
Fee
'.640
APPLICATION APPROVAL
This application is not a perfnit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in Space provided.
4
DIRECTOR'u SLO AWURV
ow-MrAIN
�Jll I
I
f
3 �f 3
BUILDING DEPARTMENT
B
Applicant Fill
PERMIT APPLICATION
Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
t
MAILING ADDREBB
V
'NAME
CITY
0
0 NUMBER
:7'
ADDRESS
V
ri
0
CITY
TELEPHONE NUMBER
Z__ 01; 10A 1�2 2
NAME
or
NEW
F7/1
RESIDENTIAL
GAS
LINE
N,ON-RESIDENTLALL I
El
SIGN
RETAINING
DEMOLISH
WALL
ALTER
EXCAVATE
OR FILL
FENCE
( x Ft.)
........ . ..........
E]
REPAIR
F-1
PRE -MOVE
INSP.
swim
POOL
DWELLING
UNITS
POSTED ON KROLL MAP 140A PERMIT
NUMBER
JOB ADDRESS
e-4
75 1
SIDE YARD SET" STREET SETBACK
I/ I
USID-ZONE Low AREA
I . " I
___1_B_L11=LD1?NqG AREA
Dvi
::5/1 (4
0 YES
KC&NT SITE
�YES r] NO
KFUNCE NUMBEI1
ST R/W DEFICIENCY THIS PROPERTY
IT. R/W
s1opes not to excead t1lo-'M
oii Standard Drawirip
if
4c,-^ i
5". ;1 " k,
STREET IMPROVED
13 YES [3 NO
loup
Valuation Fee Receipt No.
Plan Check No ..................
BUILDING
PLUM[BING z*,
HEAT & GAS LINE
FENCE
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 th In-
formation given is correct; and that I am the owner, or the duly author-
tied agent of the owner. I agree to comply with city and state laws regu-
. .
ATTEISMON
APPLICATION, APPROVAL
ZI
lating construction; and In doing the work* authorized thOr 6 bY."110 Person
*6i
will be employed In violation of the Libor Code ths itAsi'WWa�hIngton
TMSPEMUT
This application Is not a permit Uintil
relating to WorkmeWs- Compensatlim insurance.
AUTHORIZES
signed by the Building Official or his Dep-'�,
N0Tt%jF01r,nflt Limit'On-e Yedr (Except DEMOLITIONS which
ONLY THE
WORK NOTED
I ,
uty; and fees are paid, and receipt ' is ac-: -.-
I � ! 1 k
iihall bc ' o pleted In nmety days; MOVED -IN BUELMINGS ahall.-be, com-
D,
Imowledged in space provided. - :
;
�pleted lnl�fx months.)
INSPECTION
DEPARTMENT
DIRECTOWS SIGNATURE
IONA (OWNER OR,AG NT)
DATE SIGNED
CITY OF
EDMONDS
DATE
4`
NOT�: Applicant Subj�ctto Plan Check Fee
t
ji,7, er P
PR 6-1107
-
This Perrnit coven work to be done on private property ONLY.
Any construction on'the public domain (curbs, sidewalksp driveways,
-INSPECTOR
marqueesi etc.) will require separate permission.
....... ... ....