690325.pdf-- --------- . ......
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pos-rr:) ON KROLL MAP NO.: PERMIT
690325
BUILDING DEPAR TMENT Applicant Fill
Cal
NUMBER
I
PERMIT APPLICATION Inside Heavy Lines
J013 ADDRESS
22924 762 Avenue West
NAME (OR NAME OF BUSINESS)
Archie Iverson & Compnv
SIDE YAR D SITrBACK
STREET SETBACK
REAR YARD SETBACK
0
BrAILING ADDRESS
3.139 N.W. Market Street
E
USE N1
LOT AREA-
VATQLNT SITE
0 YES NO
I TELEPHUNM NUMBER
�-,�Zeattlejj Washington
SU 2-7600
NAME
Lawrence & Haxen
ADDRESS
8626 Roosevelt Way N.E0
CITY
TELEPHONE NUMBER
Seattleg Washington
La 3-o114
NA.ME
Owner
ADDRESS
CITY
TELEPHONE NUM13ER
U
STATE LICENSE NUMBER
CITY LICENSE NUMBER
Legal Description of Property (show Below or Attach Four Copies)
All of Lot 11 except the north 115 of
Skelton's Lake McAleer 5 acre tract as
nper
plat recorded in vol.
6 of plats pg.
I
2- CrIllniy
NEW
RESIDENTIAL
I
El
GAS
LINE
ElADD
NON-RESIDENTIAL
- —
F
SIGN
RETAINING
ElDEMOLISH
El
WALL
ElALTER
F
EXCAVATE
OR FILL
FENCE
( x Ft.)
.......... ..........
REPAIR
R
PRE -MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
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 laws 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 Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days: ALOVED-IN BUILDINGS shall be com-
pleted in six months.)
2 / ho C- 6
NOTE: Applicant Snbject to Plan Check Fee
This permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
BUILuINQ AREA VARIANCE NUMBER 16
-YTL—OTPLAN APPROVED
STREET R/%V
EXISTING 13TREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT,— ............ . FT.
REMARKS
Z
CHECKED BY IZI
tEMAItK8
'YPE CONNECTION
IERC. TEST
FIRE ZONE I TYPE OF CONST
C] YES [] NO
PLAN CHECKED BY
a
I
I
i
CLEARANCE
CHECKED BY
VERIFIED BY
V
PERMIT NUMBER
W
;j
RUCTION
STREET IMPROVED
0 YES C] No
i
JOCCUPANCY GROUP
ruut-A m64- Apooct K)A6 k., Tb
PC_Rjqj-T- �CJ61�0
C5LDaS F 4-
Valuation Fee Recelpt No.
Plan Check No .....................
BUILDING
PLUMBING 22-50
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTIO' N
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION APPLICATION APPROVAL
THIS I-ER311T This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
WORK, NOTED uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
INSPECTION DIRECTOR'S 81 ATURE
DEPARTMENT
CITY OF DATE
EDMONDS
PR 6-1107
FILE