690285.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
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Applicant Fill
Inside Heavy Lines
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F NO.:
PERMIT bVU28b
I 14UMBER
SIDE YARD
71,
-57
UPZONE
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SETBACK
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STREET SETBACK
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LOT AREA
I BUILDING AREA
ROAR YARD SETBACK
71�1 0
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VACANT SITE P4
C3 YES ;05 or z
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I VA—JUANCE NUMBER 11
I -STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
PLAN ST. R /W ............ FT. ........... FT.
K. to connect into sani,
no larzer line than 2"0
sewers,
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=zzl: 0413 0 No
SPECIAU INSPECTOR REQUIRED OCCUPANCY GROUP
GAS 0 YES 5.2 �O
El NEW RESIDENTIAL LINE PLAN CjiECKED BY
"�'" 1"'
NON-RESIDENTZAL E] SIGN ;4_2 �-
RETAINING REMARKS-'
DEMOLISH WALL
ALTER EXCAVATE PENCE
El OR FILL ( ........ . x .......... Ft.)
REPAIR PRE -MOVE swim
1:1 INSP. POOL
ES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE Valuation Fee Receipt No.
Plan Check
BUILDING
PROPOSED USE
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting stroets) HEAT & GAS LINE
PENCE
SIGN
tRETAINING WALL
N
SWIMMING POOL 0 1�9 /0.106
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the In- TOTAL AMOUNT DUE lo. Q 0
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 APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no Vernon
will be employed In violation of the Labor Code of the State of Washington TIUS PEIL511T This application is not a permit until
relating to Workman's Compensation Insurance. AUTHORIZES signed by the Building Off Icial or his Dep-
ONL
E - Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and f Sell are paid, and receipt Is ac-
a I completed in ninety days; MOVED -IN BUILDINGS shall be cam- knowledged in space provided.
pi end in s x monthfi-n
T) INSPECTION
DATE SIGNED
11 N TURL (OWN t AGE JR—RECTOR'S SIGNATU
DEPARTMENT
7_231 CITY OF
A0,
:1-L EDMONDS DATE
77�_077 Applicant Subject to Plan Check Fee Pl 6-1107
k_�Thjs Permit coven work to be done on private property ONLY.
Any construction on the pubtla domain (curbs, sidewalks. driveways, FILE
nuLrqueen; etc.) will require separate permission.
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APPLICATION BUILDING PERMIT Ap I . ....................................
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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 accom,,
panying plans and specifications, Two sets are submitted herewith for approval.
z
Off -St.
new alter
epair . ................. Parking ......................
Work addn r ................................................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . .
Occupancy ................................ Const. type ............................... Use zone ... S-
......... ..... Fire zone.
�"7
............. Blk ... Zl.� ..... .........
Address
Lot ........ Ad
Area.- Septic tank ......... ...... ...... I ...........
Lot frontage .......................................
............ 1. side ... ;7 ...... ........
.............
front ....... r. side .... rear.
Bldg. set backs
a-0
Address. ............ .......
Owner...,(/ ............................ e.z;&t-X4._Tel. No.& ...........................
I t
..... Address ................................................... Tel. No .............................
Builder ..............................................................
Plans by .................... ..... ............... Address ..................................................... Tel. No .............................
........................
Remarks ......... .........................
This.por,111t covers worl- to be done
... PrIvata ... pr`apexty .. UU .......................... ............... .
.................. on
A construction on the public
ny
.........................................................................................
.................. tau
c.)
et
'Me above is a correct statement, and I agree to comply with all applicable Codes and State, la g, this:i
work.
.. ............ ...... lelbatZ.
...................... Address/
Signed Owner/Agent.... .. ........
I..,
PERMIT for the above work is.hereby approved subject to the above conditions, and to comi itli th
Plianci Vn e
tions th
roved plans and. specifications, and Building Department nota ereon.
p
fee., ...... 54- 1 ............... Recd. .. . .. . ...........
Valuation ........... i� 2 ....... Permit
Z� ........................
Building Department, By ................................... .. . . ................... Date ..... .. ....
This Permit does not cover Plumbing, Sewer or Electrical installations.