700517.pdfBUILDING DEPARTMENT Applicant FIB
Inside Heavy Lines
PERMIT APPLICATION
W,
A ME (OR NAhUJD OF B
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ADDRESS
1 11 C_
CITY
6 0 old Afal
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I El NEW
%_ADD
ALTER
REPAIR
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or
10,000/1
RESIDENTIAL
El
GAS
LINE
NON-RESIDENTIAL
SIGN
DEMOLISH
RETAINING
WALL
EXCAVATE
OR FILL
PENCE
( ........ . x .......... Ft.)
PRE -MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
I hereby acknowledge that I have read this application; that the In-
lormation given to correct; and that I am the owner, or the duly author-
ted agent of the owner. I agree to comply with city end state laws regu-
iting construction; and In doing the work authorized thereby, no person
III be employed In violation of the Labor Code of the State of Washington
lating to WorkmeWs Compensation Insurance.
OTE: Permit Limit One Your (Except DEMOLITIONS which
11 be completed in ninety days; MOVED -IN BUILDINGS shall be com-
tdAa-IJK months.)
NOTE: Applicant Subject to Plan Check Fee
ft Permit covers work to be done an Private property ONLY.
construction on the public domain (curb@, sidewalks, driveways,
marquees, etc.) will require separate permission.
ON KROLL 3utp No...
PERMIT
700
NUMBER
DRESS
A J!r 0� f
— V
rARD SETBACK
STREET SETBACK
REAR YA
;ONE
LOT AREA
VAUJLXI X 9
1
1 C3 TES
I 13UILDINU _ARZA1
VARIANC]
PLAN APPROVED
EXISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ In.
5
13 YES
Plan Check No ................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I
DEFICIENCY THIS PROPERTY
Valuation
.<a "t cc r
YES [3 NO
Fee
No. 1.
TOTAL AMOUNT DUE
AMOUNT
�77 71
ArKENTION
APPLICATION APPR WAI
THIS PERMIT
'Jim
rAUTRORIZTA
This application is not a pernlit until
TB
signed by the Building Official or his Dep-
0 1
NLY THE
11 �
WORK NOTED
1
uty; and fees are paid, and receipt to ac-
knowledged in space provided.
NSPECTION
I N cTIC
CITY OF
EDMONDS
PR 6-1107
903
ISTED Oli
BUILDING DEPARTMENT Applicant M
PERMIT APPLICATION Inside Wavy Unes JOB ADORE
NAM (OR NAMP OF IWBINEBS)
SIDE YAR"
0'/ 41 hlwv 'fa j
MAILING ADDRESS
to USE ZONE
TELEPHONE NUMBER
oo Jud
W/ -I/ ell
NAME
PLOT PLAr,
ADDRESS
STREET B/
I
L ill" NO.: PERMIT
NUMBER 700517
lu A*c 0#191 - lot).
ACK STREET SETBACK REAR YARD SE7
LOT AREA --VA—CANT SITE
C3 YES -orm
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
CITY TELEPHONE NUMBER
COMP. PLAN ST. R/W ............ FT. ............ 1"T.
oe t
i v
L / / -JOG
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ADDR--
CITY
&
TELE
XHONE NUMBER
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METER 812
Legal Description of Pr perty (Sh slow or Attach Four Copies)
1 9 show
7 3 4-C46 I
Vag/ lljqllie!�e 0440,01110*v
N
GIA
K RESIDENTIAL NE
L 8
NEW
NON-RESIDENTIAL SIGN
RETAINING
DEMOLISH 0 WALL
ALTER EXCAVATE FENCE
1:1 OR FILL ( Ft.)
.......... x ..........
PRE -MOVE SWIM
REPAIR
INSP. POOL
I NUMBER OF
0 YES
OF
DWELLING
UNITS
NATURE OF WORK wo SED ONEI og
00
Plan Check No .....................
BUILDING
elturolIED USE
PLUMBING
12
Ps
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application: that the In-
formation given is correct; and that I a= the owner, or the duly author -
Ind agent of the Owner. I agree to comply with city and state laws regu-
ATTENTION
Isung, constrtiction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
I
THIS PERMIT
relating to Workman's Compensation Insurance.
AUTHORIZES
NOTE: Permit Umit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
Pet months.)
ON (OWNER OR AG TY DATE SIGNED
INSPECTION
DEPARTMENT
Al L o
jo
CITY OF
[ONDS
NOTE: APPlicant Subject to Plan Check Fee
PH 6-1107
This perrnit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
nwquees, etc.) will require separate Perulds81012-
5
Valuation
0
ar
[] YES [:) NO
Fee
707
71
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.
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