700328.pdf4
E708TED ON KROLL
i,NG DEPARTMENT
Applicant Fill
IT 'APPLICATION
Imilde Heavy Lines JOB ADDRESS
79M or USINEIIS)
4 0
0W.MRAMC I
:t
Oil -
CITY LICENBIG 14UB
tion oUproperty (Show Below or Attaun �uur
V�
Q
IN
RESIDENTIAL LINE
9�NEW NON-RESIDENTIAL Q SIGN
EADD RETAINING
l EJ DEMOLISH WALL
ALTER EXCAVATE FENCE
El OR FILL ( ......... X .......... Ft.)
PRE -MOVE swim
El REPAIR INSP. POOL ,
PERMIT
NUMBER
05
700328
0 YEs
E3 NO
nk�.. f..
EXISTING STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ rr- ............ IV.
REMARKS
[3 YES [I NO
DWELLING
UNITS
OF WORK TO BE DONE
Z
-94L)C, P.M -
Plan Check No .....................
�BUILDING
OPOSED USE
�LUMBING
PLOT PLAN (IndIcaFe Building setbacks, abutting streets)
HEAT & GAS LINE
FENCE
SIGN
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
I
'her
formation given is correct; and that I am the owner, or the duly author-
forma"' n g
ized agent of the owner. I agree to Comply with City and state laws regU'
'red agent C
ATTENTION
isting construction; and in doing the work authorized thereby, no person
I ti e
a ng _Ohel
be employed in violation of the Labor Code of the State Of Washington
be * np1
I
THIS PERMIT
wi
will
relating to Workmen's Compensation Insurance.
rel tWg to
AUTHORIZES
ONLY THE
LNOTE: Permit Umit One Your (Except DEMOLITIONS which
I
WORK NOTED
&hall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
I
plated In six months.)
NSPECTION
SIGN RE (OWN ER OR AGENT) LJAX� ML NED
G
DEPARTMENT
CITY OF
EDMONDS
�70TE: ApplicanilSubject to Plan Check Fee
PH 6-1107
This Permit covers work to be done on private property ONLY.
Any construction an the public domain (curb@, sidewalks, driveways,
marquees, etc.) will require separsite PerfolfisiOn.
[3 YES [3 NO
Fee
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-
lmowledged in space provided.
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5
APMATION
OF , EDMONDS
IING PERMIT
BulMing Department
Appl. No . ........
Permit limit, one year
is hereby made for a permit to construct the following work, in accordance with the accom-
specifications. Two sets are submitted herewith for approval.
Offst.
ter
Parking
.......................................................................................................... . .....
................................ Use zone ....
..................... Const. type fn .............. Fire zone ...........................
C
.................................................... 1,ot. ....................... Blk ....................... Addn ......................... . ....... I....
....................................... A A*rea ........................................... Septic tank ...............................................
front.... ..................... r. side ............................. 1. side ............................. rear ......... I ....................... .
1404 ........ ,
"OA ... .. 44.evn .................. Address.APAP ....... m ................ �4a<el. No ................ . ..
. . . . . . . . . . . . . .
��'Bader . .................................. : ............................. Address ................................................... Tel. No ..............................
M�'
plalli, JJ:Yj.
.. .......... Address .................................................... Tel. No ..........
................ 7"
............ ......................................
RemarkiL.',.'.� .............................................................................................................................................................................
7%e above i6'a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
-work.
Ign Address ........................................... Date ............. .... . ...
. . . . . . . . . . . . . . . . . . .
Si ed Owner/Ag
PERMIT for the above work is hereby approv4 subject to the above conditions, and to compliance with the ap,
proved plans and specifications, and Building Department notations thereon.
Valuation .............. P . .............................. Permit fee ...... *..�� ................ Recd. by .... /I/ .......... .. ......
do, W ................
Building Department, By .............. W::Z ....... : ........................................... Date ...........
INSPECTION RECORD
Fdn, OK ............................................ Frame, OK .................................................... Final, OK ....................................... .
This Permit does not cover Plumbing, Sewer or Electrical installations.