690156.pdfBUILDING DEPARTMENT Applicant rm
PERMIT APPLICATION Inside Heavy Lines -jo—i
NAMM (OR NAME ' 9P BUSINESS)
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JffAEEJNG ADDRESS
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PERMIT
NUMBER—
T 'SETBACkt 14
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YES X—N 0
VARIANCE AWMFITIR
E1aSTZNG STREET R/W
COUP. PLAN ST. R/W ...... _.FT.
REMARKS
FIRE ZONE TYPE
OPEC
[3 YES E3 NO
GAS
RESIDENTIAL
EEII
NON X IDENTIA
-RESID
El L El SIGN
Nr RETAINING
DEMOLISH WALL
ALTER MCCAVATE PENCE
11 OR FILL El ( ........ .
REPAIR 13 PRE -MOVE El SWIM
INSP. POOL
I
PLAN CHECKED BY
REMARKS
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
�A�"o
0-vt
MIND Chock
PROPOSED UBE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
4
HEAT & GAS LINE
FENCE
t
SIGN
RETAMING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
IMCCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that r have read thin application; that the 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 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
Two PERMCIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; M0VEII,-IN BUILDINGS shall be oom.
plated In mix months.)
0 AGE DATE SIGNED
SIGNATURE r R NT)
INSPECTION
,fR
DEPARTMENT
su;�
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit coven work to be done an Private property ONLY.
Any eonsftgcttcn an the public domain (curbs, sidewalks, driveways,
marquees, ote.) win require separate Permission.
690156
DEFICIENCY THIS PROPERTY
0 YES 0 NO
3.'s-0 0 �0'u I / 4z- S'0-
4k
No.
I eo-b I j4?s-4
APPLICATION APPROVAL
TMS 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.
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HPILICATION
SUILDING POW
Appl. No.-.2
WY OF MMONDS
BulMing Depafflftnt
..... . . . .....
Permit liznit� one year
ON is hereby made for a permit to construct the following
work, in
accordance with the acoom-
g plans aiid specifications. Two sets are submitted herewith for approval.
alter
repair
...................
Off'St.
Parking
....... Const. type ... ............................. Use zone ... ?f ..S� ........ Fire zone ...........................
te- e4z? � (Z^�
........ ... Lot ...... ta ......... Blk ........................ Addn ......................................
A
ritage ....................................... . Lrea .... aa:�I,.7..z ........... Septic tank ........ ........ ........................
............. r. side ......... ......... 1. side ...... ............. rear ..... ..............
Addrem ... /J—Z .... Tel. No .... 6...
....... .............. ................ ............. Addrew ..................... ............... ............. Tel. No.... .................
by ................................................... . .... ......
Address ......................
.................................................... ..................................................
Tel. No .............................
,The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work.,
e'Q
Signed Owner/Agent . ...... ddress ........................... ................. Datel
...................
PEMff for the above work is hereby approved, subject to the above conditions, and to compliance with the ap-
proved plans and specifications, and Building Department notations thereon.
Valuation ... .................... Permit fee ..... :Z�.(92 ......... Recd. by -A .... ... ..
Building Department, By ..................................... 1�� . .................. Date ... ................................
NOTE — This permit does not cover plumbing, sewer, or electrical installations, nor does it permit any work to be
done in the Right of Way areas. Driveways and walkways must be planned to meet the official grades of streets
and alleys, and plans for future sidewalk development.