690004.pdfas W I
BUILDING DEPARTMENI
PERMIT APPLICATION
NAME (OR
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A
C
W.
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Applicant Fill.
inside Heavy Lines
F)W
NEW
RESIDENTIA
0
GAS
LINE
NOW -RESIDE
SIGN
RETAINING
F1
WALL
DEMOI-18M
EXCAVATE
PENCE
ALTER
OR PILL
( = Ft.)
REPAIR
PRE -MOVE
INSP.
......... . ........
SWIM
POOL
CR or
DWELLING
UNITS
1�1 I �'- �
YARD SETBACK
STREET DETBACI
Z014E
)5 C
LOT AREA
ftAR YARD BET13ACK
YES
13 NO
USTIN44STREET R/W DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... I". .........
4
[3 YES
Hf%
0-150' 0 No
s for the building sprinklers and the
grease hood extinguisher system to be s_u'5—__
mitted and approved before installation.
Plan Cho* NO....
PROPOOZ17 WOE
_V� 14c_ 63�'� r, 0 44's a
BUILDING
PLUM33ING
PLAN (Indicate Buttaing setbacks, abutting streets)
HEAT & GAS LINE
PENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby "jnowledge that I have read this application; that We 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 recu-
I&Ung constructlon; and in doing the work authorized thereby, no person
ATTFUMON
will be employed in violation of the Labor Code of the State of Washington
THIS FERN"
r@I&Ung to WorkmeWs Compensation Insurance.
AUTHORIM
Negs:: Permit UpMt One Your (Except DEMOLITIONS which
ONLY Tax
WORK NOTED
completed In fil3ktr days; MOVED -IN BUILDINGS shall be com-
Is six months.rz
INSPECTION
DEPARTMENT
MY OF
EDMONDS
PR 9-11#7
Ito U (0 01"GENT)
Ile /Irc�4�
DATE SIGNED
NOTE: Applicant Subject to Plato Uji�k Fee
'This ramit coven work to be done an Priv"s PWPW97 ONLY -
Any constraction an the pubile domain (ewbs, ddGw&W, driveways,
m&vquwg, etc.) will require separate permission.
Valuation
CIO
� 1 5`7 -0JR-
P.L
7
APPLICATION APPROVAL
NO.
This application is not a pernilt until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imawledged in space provided.
FILE I
I � I
j
0,41 CITY OF EDMONDS
I DEPARTMENT OF BUILDINGS
CERTIFICATE OF OCCUPANCY
IN" 14 11 UNIFORM BUILDING CODE, Sec. 306
At — 530 - 5th renue South Building Permit Number 690004
occupancy established by this certificate: I Fire Zone TT I No. Stories
Type Const. V Basement
R-3 R R
Floor Load signs in . place (per Sec. 23o8 U.B.C.) — Capacity signs posted (per Sec. 3301 W U.B.C.)
Floor load and roov; capacity signs, when required, inust reniain posted at all times.
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ECTIONS
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