700282.pdfUILDING DEPARTMENT
PERMIT APPLICATION
NAME
—jXD—RES
61—Ty
NAME
—ADDREE
CITY
—ET—ATE
�?e7 �,
Legal D
Z
CENSE NUMBER
-0/- 79V�
Applicant FM
Inside Heavy Lines
I 17X - ell
or
RESIDENTIAL
GAS
LINE
NEW
NON-RESIDENTIALJ
SIGN
RETAINING
QDEMOLISH
WALL
ALTER
F]
EXCAVATE
OR FILL
FENCE
( x Ft.)
........ . ..........
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
SR OF
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
relatilog to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In mix months.)
NO.: PERMIT
NUMBER
J-3-
USTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ FT.
[3 YES
El NO
4W -i gAim- -
Plan Check No .....................
BUILDING
PLUMBIT XG
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
lii;;:� I , —701
AVOTE: Applicant Vbject to Plan Check Fee
This Permit Covers work to be done on private property ONLY.
Any construction on the public domain (curbs� sidewalksp drivewaYst
marquees, etc.) win require separate permission.
C3 YES 13 NO
DEFICIENCY THIS PROPERTY
............ FT.
[] YES 13 NO
Valuation I Fee I Receipt No.
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building official or his Dep-
ONLY THE
uty; and fees are paid, and receipt Is ac-
WORK NOTED
Imowledged in space provided.
INSPECTION
D=CTOR*A. BIG - A
DEPARTMENT
A
CITY OF
a 4 V�_ —
DATE
r
2_� *76
EDMONDS
PH 6-1107
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AATION i NUING "ORNIT Appl. No.
WI NDS Bulkling Deparhowt permit luiluit, one- year
0
struct the following work, in accordance with the accom,
is hereby made for a permit to con
are submitted herewith for approval.
and specifications. TWO sets
7� 9
-panym plans
.................
off'st.
new
P alter
... Parking ......... . ...........
.....................................................................................
addn repair
�r ............. Use zone ..... .......... Fire zon ......................
e ...... ......
............
...... Const. type
....... .................
/�'z da Blk ........................ Add . ....................................
.......................................... 1.00t...—a
..........
dn%&.
.....................................
e
ti tank ......
-V �'LbVfror "ki
. . . ......... Area .............................. . . .. ... Sep c
AV
.....................
1. side ............... ........ rear ..........
�Bldg. M*4=6 — front ........................... I si .... ......
................. ... .....................
0' wner. . ....... telAd .. ZI ........ Tel. 770
lee dress.,/;;M/----)
..........
......... ... ... ... ....
IBuilder .............. a"
. ....................... Address. ................................................... Tel. No ....... .....................
........... Address .................................................... Tel. No .............................
Plans by ......................................................
Remarks. .................................................................................................................................................................................
The above is a correct statern and, I agree to comply with all applicable Codes and State laws regulating this
work.
0 .... . ... ..............
Signed Owner/A ...... ... .. ....... .. . ........... Addre&%/�..,5.
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. 02
Valuation ........... . ............. ... ..
.................. Permit fee ....... . ........... Recd. by .....
Building Department, By ....................... z /V/ .............. ................... Date ............... ................
INSPECTION RECORD
Fdn. OK ............................................ Frame, OK .................................................... Final, OK ............................... 0 .......
This Permit does not cover Plumbing, Sewer or Electrical installations.