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BUILDING DEPARTMENT
PERMIT APPLICATION
Applicant IS
Inside Heavy Lines
POSTED ON FROLL MAP NO.: 1PE"T
690032
JOB ADDRESS
ILO& 66
"r A_V�
NAME (OR NAME OF BUSINESS)
-Tux
SETBACK
STREET SETBACK
REAR YARD SETBACK
3DUEUrG ADD iNSS
USE ZONE
-ECTAREA
VACANT am
=a NO
ED tA o L) C>
TELEPHONE NUMBER
HEIGHT
I nUMLLDING AREA
VARIANCE NUMBER
0�
NAME
PLOT PLAN APPROVED
ADDRESS
STREET R/7'
EXISTING STREET R/W ........ .. XT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ........ ... rr-
0
CITY
TELEPHONE NUMBER
REMARKS
NAME
FL Pa>i �_N
ADD=
clo z
CRECKED BY
CITY
TELEPHONE NUMBER
A -
METM SIZE SERVICE SIZE
CLEARANCE
CHEOXED BY
114
STATE LICENSE NUMBER
CITY LICENSE NUMBER
REMARKS
Legal Description 09 Property (Show Below or Attach Four Coples)
TYPE CONNECTION
VERIFIED BY
PERO. TEBT
PERMIT NUMBER
ki
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STRICET IMPROVED
YES (3 No
SPECULL INSPECTOR REQUIRED
[3 YE13 [3 NO
OCCUPANCY GROUP
GABE
RESIDENTIAL LIN
D NEW
NON-REBIDENTLALL 13IGN
RETAINING
ElDEMOLISH WALL
DALTER EXCAVATE PENCE
on rim ( ........ . x .......... Ft.)
REPAIR PRE -MOVE SWIM
El INSP. POOL
PLAN CHECKED BY
REMARKS
NUMBER OF
DWELLING
UNITS
NATURE OF WOR�TO BE DONE
Plan Check No ................. ...
BUILDING
Valuation
Fee
Receipt N07
-:a�l
PROPOSED UBE
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
0 49 (9
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read Win application; that the In.
formation given to correct; and that I am the owner, or the duly author.
ized agent of the owner. I agree to comply with city and state lawn regu-
lating construction; alul in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workman's Compensation Insurance.
NOTE: Permit Limit One Your (Except DEBIOLITXONS which
gheal be completed in ninety days; MOVED -IN BUILDINGS shall be oom-
pleted in six months.)
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTUMT
C TY OF
MMONI)s
PH 6-1101
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.
PH 0 A
DATE SIGNED
DIRECTOWS SIGNA
V-t-
NOTE: Applicant Sub(lct to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any enestraction on the public domain (curbs, sidewalks, driverways,
nwquoes, etc.) win require sapwMe permission.
rum
I
Building Permit Application I I.Stdff =6
NAME (OR NAME OF BUSINEUB)
/09 / Ad CZ*4FA Al //Vog C: 0,
f4 MAILING ADDRESS
CITY I TELEPHONE N
4W AA 0 m 4 S. I
(!�AA,APSPie-e- Alet))y /,&C..
X)DREBB
1/2 0 al AIA,
1ITY PHONE NUM
5,& /s 77,4 3,1 / 3 Z,
hi-L- S/
;4
BUILDING
PERMIT
NUMBER
[] YES
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
Required
NEW
Li DTMOLISH
ADD
1 :5 / IAI
I
—ALTER
REPAIR
I
F-1 RESIDENTIAL
WNON-RESIDENTIAL
NUMBER OF
DWELLING
I UNITS I
F-1
I hereby acknowledge that I have read this application; that th In-
formation given In correct; and that I am the owner, or the duly Mar-
Ized agent of the owner. I agree to comply with city and state laws regu-
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
relating to Workmen's Compensation Insurance.
NOTE: PERMIT LIMIT ONE YEAR
PLAN CHECK &
FILE
5
0 YES 2r-N�o
ZIN 0
! NOER
NO
NO. OF BLDG*.
PZRIBLDG.
TOTAL PIK
Z
1
BUILDING
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
BEAT & GAS IMM
4
PERMIT FEE
—
5
D&hfQ&FAeIq""
PERMIT FEE
6
AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Director of Building Inspec-
ONLY THE
tion, or his deputy; and fees are paid, and
WORK NOTED
receipt is aelmowledged in space provided.
INSPECTION
DEPARTMENT
DIRE3T,�",BIGNATURE
CITY OF
DATE
EDMONDS
PR 6-1107