700318.pdfUILDING DEPARTMEN
PERMIT APPLICATION
4
Applicant Fill
Inside Heavy Lines
OSTED ON KROLL MAP NO.:
)B ADDRESS
/ gp 0 &1 — R 6""
ME YARD SETBACK STRE
JOE ZONE LOT
PERMIT
NUMBER
YES
NAME
I
PLOT PLAN APPROVED
ADDRE1313
STREET A/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. .......... M.
CITY
TELE PHONE NUM13ER
REMARKS
V
NAME
Al;
ADDRESS
ICHECKED BY
CITY
TELEPHONE NUMBER
L
^7
I
METER SIZE SERVICE SIZE
CLEARANCE
ICHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER
I
Q
MNEW
0 �--
ALTER
REPAIR
low or Attach Four
FIRE
RESIDENTIAL
NON-RESIDENTIAJL
GAS
LINE
SIGN
0 YES [3 NO
PLAN CHECKED BY
m�
DEMOLISH
RETAINING
WALL
REMARKS
EXCAVATE
PENCE
OR FILL
( .......... x Ft.)
EPRE
]
-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-
tzed 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; MOVED -IN BUILDINGS shall be com-
pleted In six months.) _
f
20
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done an private property ONLY.
Any construction an the pubtle domain (curbso sidewalks# drivewayst
numquees, etc.) will require separate permission.
90 0.-�,
Valuation
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
[] YES 13 NO
Fee
600
* "OuNT
TOTAL AMOUNT DUB
ArTEIMON
T 1
APPLICATION APPROVAL
TI us
THIIS PERMIT
PEPm,
rAUTHORIZES
This application is not a permit until
TIS
ONLY THE
0 TH,
signed by the Building Official or his Dep-
= NOTI
ORK NOTED
W Wo
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
I INSPEcTIO
NSPECTION
CITY OF
EDMONDS DATE
PR "7-IS-76
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APPUOATIO BUILDI "NO -,"PERMIT Appl. No.
.:�'CITY OF EDMONDS Building Department Permit limit, one year
A r PPLICATION is hereby made for a permit to construct the following work, in accordance with the, acwm-,.
g plans and specifications. Two sets are submitted herewith for approval.
new alter Off -St
kaddn repair ............................ ........ ............................................................................ Parking ......................
upancy ................................ Const. type ........................ V Use zone ..... ....... Fire zon .4 ...........
UJ, ('91 V,-Z%C�/z ,- ---- �tl- -
....... Blk ..................... .
Address..,./.6..1.!2 ddn ............. .....................
.................... Area. ........................................... Septic tank ...........................................................
Lot frcatage ....................
Bldg. setbacks frontL ........................... r. side ............................. 1, side ..................... rear ...............................
..........
No
Owner ... (14� ...... ....... . ..... ..... Tel ......
..............
Ider .......... Address ................................................... Tel. No ............
Dui .........................................................
el
............................
Address .................................................... T No
Plans by ...............................................................
Remarks.................................................................................................................................................................................
............
........................................... I ......................... ........ ..................... ...... ....................................................... ...... ......... I
................................................................................................ ................................ ..............................................................
The above is a correct statement, and I agree to comply with all applicable Cocks, and State laws rejuliting this
work.
Address ............................. ........ I ......
Signed Owner/Agente..4a<A6.1LA q
PERMIT for the above work is hereby approved, subject to the above conditions, and tDcompliance with the ap,
proved plans and specifications, and Building Department notations thereom
Valuation ........ ��CA.5 ........................... Permit fee..* . . . .................. Recd. by .... A_416�7 ... .... ..............
.................................................... . ................... Date ............ d ... . ......................................
Building Department, By.
This Permit does not cover Plumbing, Sewer or Electrical insta][lations.
V
& WORK PERMIT C
APPLICATI Application No . .......... .. ...............
Building Department permit Limit, One Year
CITY OF EDMONDS
e rk, in accordance with the accompanying plans
PLICATION to hereby made for a permit to construct th following WO
d specifications:
New Residence A
WORK— New/Addn . ....... ..................................................................................... Ground Area ................................... NO. StOrleslm- bsmte
Erpme ................... Height ..... .......
Pee Wee Investment. Inc . .................................. Const. Type ....... ...........
PlansSubmitted ....................................................... . .................
3
12.... Fire Zone ....................
Use Zone ..... ......
JAWATION Address ..... ......... �..4 ...... ........ . %..**
See attached
.. ...............................
........... B101 ................... Add'n .............................. .......................................... . ..................... Sewerage.. Sewe red
25, Sides .... T*
Front and Rear ............................... ..... . ............. .
. . . ............................ WidtlL ........................... Min. Bldg. Setbacks,
6th S-1 .. ....... . .......
ee We ..!MAtment. Inc . ..................... Address ..... 0 .................. 4.x ... !Zm 9*1toneLl..2-4355
e ............. . .................
........................... Phone ........................ .......
....................................................................... Address .............................................
...... Phone ........................ .......
.............................................................. Address ..................................................................
................................................................ Phone ....................... . .......
............................................................ Address ........
... Address ........................................................................ Phone ....................... . .......
............................................................... . ....................
Phone ..................
..............
Jjj............................................................................................ Address ........................................................................
K. ......................................
... ...................................................................
. .......................................................................................................................
.......................................................................................................................................
..................................
............................................
................................ . ......................................................................
...............................................................................................
........................... . ..
..............................................
...........................................
.................................................................................................................................................
y with all applicable Codes and State Laws regulating the work.
correct statement and I agree to compl
The above is a
F 'D� 1/63
Sme ..... Date..V� ... . ....... ......
Signed: Owmr/Ag .. . .... . 11
.......... Address .......................................................................
conditions, and to compliance with the approved plans
PERMIT for the above work is hereby approved, subject to the above
and specifications and Building Department notations thereon.
4 F
VALUATION PEFJ41T FEES
$ Bldg . .... ................
Plbg. .......
Heat.... $ ...... .............................
APPROVED:
Elect..... $ ........................................
Date............... J .............................
BUILDING DEPARTMENT Others ... $ ........................................
So
TOTAL FEE ..... V ................. .
.............
BY ................
ci neer's inspection shall be covered before inspection and approval.
NOTES: No work requiring B46(ng7De�partmen or
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.