690219.pdfr
BUILDING DEPARTMENT I Applicant FIU
I Inside Heavy Line!!
PERMIT APPLICATION 11
P NO.: PERMIT
NUMBER 690219
� LNG �11 Ai
IMAILLNU "�J�00 SITE
4 /
USE ZONE I LOT AREA Z
0 [3 No
6 Ea [3 YES
D CITY TELEPBONE NUMB
CITY 6 �. 'BUILDING AREA �NUMBER
11EIGHT
JV 0,
14-0
TEIE
VACANT
0 a
Z/,- V ERIANCE NUMBER
NAME
PLOT PLAY APPROVED-
%J40 r1Jr V1 k
�4 tAD D R E 8:8
REET /W
=0 STREET
13656 S 0 A) f_,09 R/W ... ....... F-r. DEFICIENCY THIS PROPERTY
- CITY HONE NUM.B.K__ EXIB
6-1—Ty COMP. PLAN ST. R/W ............ ............
6— 3,503S" REMARKU
NAME
5-m—A "VAR CEAJ
Z
NA' '"'
:4 rADDRES8 '
KED BY
Of Y I TELEPHONE NUMBER
CITY
E4 'CKED BY
A M.ETER SIZE SERVICE SIZE CLEARANCE CHE
STATE LICENSE NUMBER CITY LICENSE 14UJU---
_ff EMARKS
LeFa—I Description of Property (Show Below or Attach Four Copies)
y�� v .-tt� W �� iol� AW4— do 16 TYPE CONNECTION VERIFIED BY
*L
4
.1 epr lesy
0 FIRE ZONE or C
SPECIAL INSPECTOR RE9
r _AT C] YES 0
RESIDENTIAL LINE PLAN CHECKED BY
NEW
NON-RESIDENT AL SIGN /;///7
ADD
ElDEMOLISH WALT
ALTER EXCAVATE FENCE
F� OR FILL El ( ......... A ..........
REPAIR PRE MOVE swim
INS;. POOL
TR OF
DWELLIZ40
UNITS
NATURE ulp wor.1, xu BF, DONE
:6 plan Check No ............ . .......
BUILDING
—PROPOSED �USE J V PLUMBING
HEAT & GAS LINE
A PLOT PLAN (Inuicarle, Jsullul-15 abutting streets)
PENCE
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
I hereby acknowledge that I have read this 51)1111cati0n; that the in-
formation given is correct: and that I am the owner, or the duty author-
Ized agent of the owner. I agree to comply with city and state Iowa regu-
ArrrJMNTION
lating construction; and In doing the work authorized thereby, no person
Labor Code of the State of Washington
THIS PERMIT
will be employed In violation of the
AUTHORIZES
relating to Workmen's Compensation Insurance.
ONLY TILE
NOTE: Permit Limit One Year (Except DEJ%1OIATIONS which
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months-)
INSPECTION
IE I I 1 1 � 111 IT) DATE SIGNED
SIGNATIJRE (OWNE �,N
�515 T) , �1"
DEPARTMENT
6 19
CITY OF
EDMONDS
UNOTE: APPlicant Subject to Plan Cbech Fee
PH, 0-1101
This Permit covars work to be done on Private property ONLY.
domain (curbs, sidewalks, driveways,
Any oopjtructlon on the public
marquees, etc.) will require separate permission.
Valuation
4,
13 YES
Fee I Receipt No.
S6-1
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.
UIRECTOR'S SIGNA'�URE�
L-7
D
FILE
Sewer
Parking
Landscaping
Fire Dept.
11 - _ ".. - I- .- -1-1 __
....... ...
ATION & Wr' JING PERMIT
No .... 4_1
DMONDS Building Department Permit limit� me year
4 is hereby made for a. permit to construct the following work, in accordance with the accom-
d specifications. Two sets are submitted herewith for approval.
alter Off -St.
ir ....................................................... Parking .......................
r.......
....... Use zone.A�_.Lk ...... Fire Zone ..... .............
--- Blk ........... . .... . .. . .
....... ------------ ( 11
-W 7 -V-)
x4
................
. ........... Septic tank.� ... ...... .......... . ........... .........
rontage ........................................ Area.
t f
f
Bldg. front ------- - ...... )�' r. side ........ ............ 1. side .............................. rear ..... .................
set
Owne . .... ........ Address.2,P el. No.?,G =..Vd 2b 0
r .. ;�� ( e
Builder................................................................... Address ................................................... Tel. No .............................
Plansbv ................................................................. Address .................................................... Tel. No .............................
Remarks...............................................................
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work.
Signed Owner/Agent .... ..................... Addres� ................................... . ....... Date
......... ...
PERMIT 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. .1-1 L7
Valuation .............. .......... Permit fee ..... ::5.0 ........... Recd. b ......... ......................
BuildingDepartment, By .......................................... 0j.4.4 - - ----------- 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.
tj
----------- ... .....
APPLICA��..,ON & WORK PERMI�-
Application No . .....
CITY OF EDMONDS Building Department Permit Limit, One Year
APPLICATION is hereby made for a permit to construct the following work, In accordance with the accompanying plans.
and specifications:
WORK — New/Addn . ............
.............. .. .................................... Ground Area ..................... . ............ No. Stories..__..
Plans Submitted ....... Const e .... Height. .....................
5)
C,
.... 3"K ;r
.... .........
LOCATION — Address. .... . . . . ........... .. % .. . ..................................................... Use Zone..�65.f Fire Zone ....................
RecordedLot ........ . ......... Block. ................... Add'n ............................... .......................................... . ..................... Sewerage .... ....................... . ....
Sides .......
Lot Area .................. .................. Width ............................ Min. Bldg. Setbacks, Front and Rear .............................. . . ...... . .. . .........
Owner ..................... . . .............. ...................................................... Address .......... / ....... . ........................... .
Plansby .... . ............ . ........ . . . ......................................................... Address ........................................................................ Phone ........................ .......
Bldg. by ...... . .......... ............. I .......................... , Address .................................................... . .................. Phone ......................... ......
PIbg. by ........................................................................................... Address ........................................................................ Phone ............
Heatingby .............................. . ....................................................... Address .......... ............................................................. Phone ................................
Elect. by ............................................................................................ Address ........................................................................ Phone ................................
Remarks
The above Is a correct statement and I agree to comply with all applicable Codes and State Laws regulating the work.
Signed: Owner/Agent ...... z
.Or,_./4z ................................. Address ............................................................................ Date..
�6 14rzu�
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the approved plans
and specifications and Building Department notations thereon. .1
VALUATION PERMIT FEES
0
$ ......... ... Bldg . .... $ .................. 1-:: . ..
..... ... ......
PIbg. . . . - $ ........................................
APPROVED: Heat .... $ ........................................
Date............. ....... ................. 11 ....... ........................ Elect. ........................................
BUILDING DEPARTMENT Others ... $ ........................................
.... (Lq
-!e TOTAL FEE $ ........................................
By.................... . ...........................
NOTES: No work requiring Building Department or City Engineer's Inspection shall be covered before inspection and approval.
Twenty-four (24) hour notice requested. Contact the City Engineer prior to construction of all site utilities, such as
curbs, paving, driveways, sewer, water and street connections.