700243.pdfBUILDING DEPARTMENT I Applicant Fill
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8
PERMIT APPLICATION Inside Heavy Lines
NAME (Oft 14AMJU OF BUSINESS)
ZVONG ADDRESS
7,57V� // AL -Lit - 061 C `E�
CITY TELEPHONE NUMBlia
I t. -_7 / I' )(-
t> U) IV f=- 0-0,
or Attach Four
NEW
RESIDENTIAL
El
GAS
LINE
NON-RESIDENTIAL
SIGN
0 A"JJ
RETAINING
WALL
ALTER
D
DEMOLISH
EXCAVATE
OR FILL
PENCE
10"i ...
REPAIR
PRE -MOVE
INSP.
swim
POOL
4UMBER OF STOR10-
NUMBER OF
DWELLING
UNITS
Ik6916D UFET
& '=$4k �
Fn, g betbacKs, aoutu
POSTED ON KROLL MAP NO.:
PERMIT
NUMBER
FOB ADDRESS
c) 3 -7o 7,V
SIDE YARD SOTBAUX, UWAZWK BET13ACK
-us-E —00—NE LOT AREA
I.?, C�' — 9 1
I hereby acknowledge that I have read this application; 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 laws regu-
lating construction; and in doing the work authorized thereby, no perxon
will be employed In violation of the Labor Code of the State of Washington
relating to Workmealm Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS nhall be com-
pleted in six months.)
SIGNAT j! �IOWNER M®R AGENT) DATE SIGNED
NOTE: Atplicant Subject to Plan Check Fee
Thin Permit covers work to be done on private property ONLY.
Any construction on the public domain (curb@, sidewalks, driveways,
marquees, etc.) will require separate permission.
EXISTING STREET R/W ............ FT.
COUP. PLAN ST. R/W ........ ... PT.
0 YES 0 NO
700243
13 YES 0 NO
DEFICIENCY THIS PROPERTY
13 YES [] NO
REM UMS I I
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PA. 6-1107
Fee
D_ 0 0 1 !S--,,
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.
- CA - I-( C)
APPLICATI( A & WORK PERMIT Application No.
2
CITY OF EDMONDS Building Department Permit Limit, One Year
W� APPLICATION is hereby made for a permit to construct the following work, in accordance with the accompanying plans
and specifications:
WORKNew/Addn. ........... W ........................ Ground Area ................................... No. Stories ............
PlansSubmitted ....................... ................................................................................... Const. 17"e ........................................ Height .......................
Address .... ....... . .... r ..........
LOCATION ..... Use Zone .................... Fire Zone ..........
...... Blocks4) ............ Add,
Recorded Lot ..... /. ... . .
. .......... ........ Sewerage .............. .....................
Lot Axea. .............. . ....................... Width. ........................... Min. Bldg. Setbacks, Front and Rear ............................... Sides ..............................
T
.. ...........
Owns .. ........... .. ..... Phon AX=7---.7,3
Plans by.
............................... ............................ Address ........................................................................ Phone ........................ .......
............................... Addresa. ....................................................................... Phone ................................
Bldg. by % .1 � -";-
..... .............. .
0 e...,aQ
PIbg. b3 ......... . ....... Addrass./'/v&�246 ..... ..
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.
e
Signed: Owner/.
........ Address ............................................................................
PERMIT for the aYove work is hereby approved, subject to the above conditions, and to compliance with the approved plans
and specifications and Building Department notations thereon.
VALUATION PERMIT FEES
62ev
...... a.Ze, e9 .... . ..... Bldg . .... $ ........................................
Plbg. .... $ ............ sox... ......
APPROVED: Heat .... $ ........................................
41' 11116
Date............ it ..... Elect ..... $ ........................................
BUILDING DEPARTMENT Others ... $ ............................... .
By ...... ...... Inspt ................. TOTAL FEE $ ...................... ...........
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.
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RECORD OF INSPECTIONS 'r
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Date Passed
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Foundation
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Plumbing (Pailial)
(ROU911)