700149.pdfA 41
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wow POSTED ON KROLL MAP NO.: PERMIT
NUMBER
BUILDING DEPARTMENT Applicant Fin 100149
1
PERMIT APPLICATION Inside Hemry Lines JOB ADDRE8S
I NAME (OR NAME OF BUSINESS)
i:
4
MA
F1NEW
DR"ADD
F-1 ALTER
F� REPAIR
rUMBER or 8
TA-TURE M
�; 4 1,,- —
TELEPHONE NUMBEZ'
77 V- V 7 /�;; -7
or
RESIDENTIAL
El
GAS
LINE
NON-RESIDENTIAL]
[:]
SIGN
ElDEMOLISH
RETAINING
WALL
FEXCAVATE
OR FILL
FENCE
( ........ _X .......... Ft.)
PRE -MOVE
SWIM
INSP.
POOL
ITE S
I -NUMBER OF
DWELLING
UNITS
K TO BE DONE
Aid zoo
-A
I . It
. Ar�
J
-7 4>
5�zi-_eei4
I hereby acknowledge that I have read thin 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 Coda of the State of Washington
relating to WorltmerVa Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In aluety daym; MOVED -IN BUILDINGS shall be com.
pleted In six months.)
� Z_
E: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domatn (Curbs, sidewalks, drivowILYS,
marquess, ate.) win require separate Permission.
�7
USE ZONE LOT AREA. VACANT SITE
13 YES NO
KISTING STREET R/W ............ FT
COMP. PLAN ST. R/W ............ FT
FIRE ZONE TYPE OF
SPECIAL INSPECTOR RE
[:] YES z4qtr--
PLAN CHECKEDPY
A-0/A.Y.-
Plan Check No ............
BUILDING
PLUMBING
IIE, AT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
'TOTAL A31OUNT DUE
ATTENTION
TIHS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMWT
CITY OF
EDMONDS
PR 6-1107
DEFICIENCY THIS PROPERTY
0 YES
Fee
Z
04
I
Z
Wy
BY
I /.-I � I Z) W, 5
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or Ids Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
1-n
V -I
3
I
N'R
APPUCATION BUILDING PERMIT
Building Department
IN
CITY OF EDMONDS
A U)
Appl. No . .....
Permit limit, one year
APPLICATION is hereby made for a permit to construct the following work; in accordance with the atow1u,
panying plans and specifications. Two sets are submitted herewith for approval.
Off -St.
new alter
raddn repair ....... ....... ............................................................................... Parking ......... . . .........
........................ Const. type ................................ Use zone .... r ......... Fire zone ...........................
Occupancy.'
Lot ......... Blk ........................ Ad
....... .........................
Q
Address ...... Z
Lot frontage ....... A ... eL 4�1 Area ........................................... Septic tank ....... .......................
`� . ....... 1. side ............................. rear ...............................
Bldg. set -backs — front ..... . ..................... r. side ......................
Z-7
. ................. Address,2.�'t4 Tel. Z<Z-�Zne�ZZ
Ownew
Builder............ K . ....................... Address. ................................................... Tel. No .............................
'R
Plansby ................................................................. 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.
a
9
Signed Owner/Agento.._e.�Z.;. .. Address ............................................ Date.�.=Z/ ........
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.
.4-4r
........... Permit fee...
Valuation ................ Xy ........ . .... .......
............ Reed. by ...... ..
.............
Building Department, By ..................... X�t/5.5� ................. . ................... Date .......... -_-2-:7 .. ....... 60 ....................
........... ...
INSPECTION RECORD
Fdn, OK ............................................ Frame, OK .................................................... Final, OK .......................................
This Permit does not cover Plumbing, Sewer or Electrical installations.