700349.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
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MAILING "DRESS
C TY
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Legal Descrip
FI NEW
F1ADD
El ALTER
0 REPAIR
A*ve JR
NUMBER
FY 6 7
Applicant Fill
Inside Heavy Lines
- D417&
9 ME
GAS
Li RESIDENTIAL LINE
E:] NON-RESIDENTIAL SIGN
RETAINING
D DEMOLISH WALL
EXCAVATE PENCE
OR FILL ( ......... A .......... Ft.)
PRE -MOVE swim
INSP. 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-
ized agent of the eviller. I agree to comply with city and state lawn 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 Workmen'# 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.)
17-
,2
NOTE: Applicant Subject to Plan Check Fee
This Fermit covers work to be done on private property ONLY.
Any construction an the public domain (curbop sidewalks, driveways#
marquess, etc.) will require separate permission.
NO.:
0-
EXISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ FT-
FIRE
0 Yps [3 NO
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
PERMIT
NUMBER
DEFICIENCY THIS PROPERTY 1.
Valuation
.. ........
CHECKED BY
CHECKED BY
ly
MBER
13TREET IMPROVED
YES No
�GROUP
Fee
Receipt No.
a,
TOTAL AMOUNT DUE
ATMNTION APPLICATION APPROVAL
THIS PERMIT Titis application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE t
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION DLRECTOWS SIONATU �E
DEPARTMENT
CITY OF
DATE14�,�
ED51ONDS
PR 6-1107
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APPLICATION BUILDING PERMIT Appl. No . .....................
Permit limit, one year.
ITYOF EDMONDS Building Department
ccom�
tru th 11 rk, in accordance with the a
'APPUCATION is hereby made for a permit to cons ct e fo owing wo
I d specifications. Two sets are submitted herewith for approval.
panying P ans an
Off'st.
'r— alter
V new
......................... 9—
..,�Work addn repair .......................... ........................ ........................ Parkin ...................
'bcc"upancy ................................ Const. type ............................... Use zone ... ... *Fire zone ........................
Z., ......... Lot ....................... Blk ........................ Addn ...................................... .
............. Airea ....................................
....... Septic tank .........................................................
..........................
..............................
................ rear..
-backs — front.. ................. 1. side ..............
Bldg. set .......................... r. side ............
..............
7 ( — -� I I � ";. . i
Ow — C:��"�... Tel. No ..,r
.................. Address ............................................. . .
Builder ...... .... Address .................................................... Tel. No., ............................. .
........... 7 ..............................................
..... Add ........ ....................... Tel.. No...
Plans by ............................................................. rem
/Y A
Remarks............. :IV . ........ .................................................................................................................................................
........................ ....... ... ........ ................................................................................................................................................ .
The above i a correct statement, and I agree to comply with all applicable Codes and,State laws regulatin
work.
Da
ddress ............................................. te....'
Signed Owner/Agent.. VV...J.A .... ....... ......... . .. A * . ....
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.
... . .......
........................ Permit fee ........ ..................... Reed. by ......... f .. . ..
Valuation .............. ..........
............................................ ...
Building Department, By... ............ .. ..... , ....... Date...
NOTE This permit does not cover plumbing, sewer, or electrical installations, nor does it permit.any workto be
done in the Right of Way areas. Driveways and walkways must be planned to meet the official grades of streets
and alleys, and plans for future sidewalk development-