690101.pdfB UILI
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NAME 4
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DEPARTMEN
APPLICATION
LE OF PRIJESS) -
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Applicant FIR
Inside Heavy lAnes
I "Wimad -
,..Ty IV 10, S06071 ct
CITY I Ic PHONE NUMBER
2�s4&,Votlb -1 ris I LT or, 4 ID / 0 9 1
or
NEW
RESIDENTIAL
El
GAS
LINE
NON-RESIDENTIAL
SIGN
RETAUUNG
DEMOLISH
WALL
3OCCAVATE
PENCE
I
ALTER
El
OR FILL
( x Ft.)
REPAIR
1:1
PRE -MOVE
El
........ . . ........
SMM
INSP.
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
. ............ ..
C
P No.:
PERMIT
I NUMBER
690101
rn ;-) 0 1 ln4lr� /57 1 0�� R
nLOT AREA, VACANT SITE'
ID C3 YES -)5/XO
r BUILDING AMEA VARIANCE.4NUMBER
K1875f;G-STREET R/W..._._....PT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ....... .... rr. ... ........ FT. 0
10MARKa
[] YES 13 NO
or
Plan Chock No ............
PROPUB—NDUSE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting strecte)
PLUMBING
BEAT & GAS LINE
PENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT Buz
I hereby acknowledge Mat I have read this application; that the In-
formation given In correct; And that I am the owner, or the duly author-
Ised agent of the owner. I agree to comply with city and state laws regu.
ATTENTION
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
THIS PERbuT
relating to Workman's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY TIM
WORK NOTED
shall be completed In ninety days; MOVED -IN BUEEMINGS shall be com-
pleted in &lx,*onth!,)P
A
OR AGENT) DATE PIGNEYD
INSPECTION
49
DEPARTMENT
10
CITY OF
EDMONDS
NOTE: Applicant Subject to Pidn Chelk Feel
I
PH 6-1107
This Permit coven work to be dome an private property ONLY.
AMY Construction an the public domain (corbs, sidewalks, driveways,
marquee@, do.) will nQuire separate permission.
Valuation
.00
13 YES 13 NO
No.
I a-00 I #fsi
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.
-0- /� (09
rna ct,
t
. . . . . - - - - - -
MIKJOATION & r"11.1111110 PERMIT
Appl. No.ZZ�_:i---�n�47
Building Department Permit limit, one year
%
made for a permit to construct the following work, in accordance with the accom,
Two sets are submitwd herewith for approval.
Off -St.
....... ........................................................ Parking ......................
....... Const. type ................................ Use zone ... Fire zone ...................
Lot . . ..... Addn..
...... . . ............ .......................
...................... Area ........................................... Septic tank...,.5 ........................
-fron...... ��.Z( ......... r. side ... ............ 1. side .... ............ rear..,=�.—?/ .......
t .......
..................
...... .. Tel.
Y
.......................................I. Address. ................................................... Tel. No ...............
..............
Z, - Main by ... .............................................................. Address .................................................... Tel. No .............................
.....................................................................................................................................................................
.............................................................................................. ................................................................................................
................................................................................................ ...........................................................
7
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work.
Signed Owner/Agent ..... ... ........
I .............. ...... Address ...........................................I. Date-le/22... e�l
PERMIT for the above work is hereby approved, subject to the above conditions, and oDmpliance with the ap,
proved plans and specifications, and Building Department notations thereon.
Valuation ...... Permit f ..... 3,5 ......... Rmd. by . ... ............ ......
Building Department, By .............................................. Ajl�- ... . . Date ............. .. . .......................
This Pennit does not cover Plumbing, Sewer or Electrical installations.