690249.pdfRIMINI Applicant Vill
ATION Inside licavy Lines
,fn 4-9-54
YT-L—ICENSE NUM13J
;.now Below or AM= rOur �(IVLCnl
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NEW RESIDENTIAL
GAS
LINE
NON-R
SIGN
ADD
RETAINING
WALL
DEMOLISH
ALTER EXCAVATE
R OR FULL
PENCE
( x Ft.)
.......... ..........
REPAIR PRE -MOVE
INSP.
swim
POOL
NUMBER OF STORIES NUMBER OF
DWELLING
C;Z UNITS
J
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,;Z ro D _F16
t
N
I
I hereby acknowledge that I have read this application; that the In-
formation given Is 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; 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 Workmeala Compensation Insurance.
NOTE: Permit Urnit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: APPlicant Subject WPIan Check Fee
_iiTa —rermit Cavern work to be done an private property ONLY.
Any Construction on the public domain (curbs, sidewalks, driveways,
marquess. ete.) witt require separate pernA9210"
108'rED ON IUW" MAV aU.; PERMIT
N NUMBER 61_)UZ1q,7
UMBER
L)B ADDRESS
:Q,q1 0 7 /-J
IDII YARD SETBACK STREET �SETBACK EAR YARD SETBACK
7-
ZONE' LOT AREA VACANT SITE
YES '43�O
1EIGHT MILDING AREA VARIANCE NUMBER ;W1
STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPEEVEY
COUP. PLAN ST. R/W ............ FT. .......... I
'T. 0 1 .
REMARKS
CHECKED BY
METER SIZE """VICE! SIZE CLEARANCE
BY
ICHECKED
REM.ARKS
TYPE CONNECTION
VERIFIED BY
PERC. TEST
PERMIT NUMBER
REMARKS
FIRM ZONE TYPE OF ION STREET IMPROVXD
YES
[3
PECTOR REQUIRED
OCCUPANCY
YES e_�No
C,Q=UP
Z
PLAN CHECKED BY A211 /.
REMARKS
valuation Fee
Plan Check No ............ . .......
Receipt No.
BUILDING
PLUM33ING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL ADIOUNT DUE:
sv�
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application Is not a permit until
AUTHORIZES Bigned by the Building Official or his Dep-
ONLY THE
WORK NOTED uty; and f ees are paid, and receipt is ac-
I lmowledged in space provided.
INSPECTION DIRECTOR
DEPARTMENT
CITY OF =1
EDMONDS DATE f L-/
PR 6.1101
a
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4-1 L3 .�2
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i-ti- ko C%
yyk
!A
PERMIT
i7o
BVIL.DING DEPARTMENT
ApplicantFul
NUMBER
er
PERMIT APPLICATION
Inside Heavy Lines
JOB ADDRESS,_
NAMJ SINESS)
SIDE YARD SETBACK
STREET SETBACK
REAR YARD SETBACK
IM—LING ADDRESS
;ell
USE ZOND
LOT AREA
VACANT SITE
CITY TELEPHONE NU05TR�i�l�
YES 0 NO
HEIGHT BUILDING A VARIANCE NUMBER P.
J �, , � 11 1 1 . . I I
ADDRESS
CITY
TELEPHONE NUMBER
NAME
03
ADDRESS
CITY
TELEPHONE NUMBER
STATE LICENSE NUMBER CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
7
GAS
RESIDENTIAL LINE
0 NEW
NON-RESIDENTIAL 0 SIGN
ADD RETAINING
WALL
DEMOLISH
ALTER EXCAVATE PENCE
OR FILL ........ . x .......... Ft.)
REPAIR PRE -MOVE SWIM
INSP. POOL
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Z
PROPOSED USE
PLOT PLAN (Indicate Building setbacks, abutting streets)
t
N
EXISTING . STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT.
REMARKS
I
NNECTION VERIFIED BY
MT PERMIT NUMBER
B
FIRM ZOMT.. TYPE OF CONSTRUL7XION klrXj�ENT 1A1lj1WVNL
13 YES 13 Wo
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
C3 YES -ffNO
PLAN CHECKED BY
REMARKS
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
FTOTAL A31OUNT DUE
I hereby acknowledge that I have read thin 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 laws ngu-
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
n relating to Workman's Compensation Insurance. I
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
I
p Pleted in six months.)
OR AGENT) DATE SIGNED
NOTE: Applicant Sitbject to'Plan Check Fee
This Permit coven work to be done on privets property ONLY.
constructlon on the public domain (curbs, sidewalks, driveways,
marquees, ete.) will require sepamte permission.
ATMNTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
ED31ONDS
PH 6-1107
Fee I Receipt No.
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.
DIRECTOR'S 13IGNATURE
DATE
INSPECTOR
I