710042.pdfUILDING DEPARTMENT
PERMIT APPLICATION
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Applicant Flit
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ElRESIDENTIAL
NEW
❑
GAS
LINE
NON-RESIDENTIAL
®
SIGN
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ADD
❑
❑WALL
RETAINING
DEMOLISH
ALTER
❑
OREX❑
FENC.zFt.)
REPAIR
❑
PRf-MOVE
INSP.
..........
SWIM
POOL
DWELLING
UNITS
Tv 2 5
I hereby acknowledge that I have read this application; that the In-
formation given to 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 Stale 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.)
.,
NO.: PERMIT
NUMBER
a
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
YES 0 NO
Cl YES
DEFICIENCY THIS PROPERTY
0 YES Cl NO
Gi4GC. �t�/Z. /tvS�eCTj�tL/ /�t+�r
PAO.
Fee
Plan Check No .....................
BUILDING
PLUMBING
HEAT & OAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
No.
TOTAL AMOUNT DUE I (TOTAL AMOUNT DUE l i�0���^ C��/ C
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
VATU (OWN R AGENT) DA SIGN D INSPECTION
DEPARTMENT
`;71 OITY OF
EDMONDS
NOTE: Applicant Sub ect to Plan Check Fee
PR a-IIo7
This Permit covers work to be done on private property ONLY.
Any construction on the publlo domain (curbs, sidewalks, driveways,
marquees, etc.) Will require separate permisslon.
FILE
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! ` RECORD OF INSPECTIONS
Date Passed'',
Foundation
t Plumbing (Partial)
I! ...�..-/ - .. _ _:.._............._ .....�'; r...._..... __ .._ .
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,Frame (Rough)
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_t t,. Furnace &Fuel Unes;� .7.
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did; RECORD: OF INSPECTIONS',
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: - bate.Passed.,
d-d.- 'i do d1
t f . , Drainage
Sewer.
Parking
Landscaping. _, ;
Fire Dept.
+m�wo.+rfmry.•nw.awv+se.rT v..•"a"`�tu.s.r4.�«-+..+.....
APPLICATI�- 4 & WORK PERMIT � '%L�-�
Application No. /.....(.................
,
CITY OF EDMONDS Building Department Permit Limit, One Year
APPLICATION is hereby made for a permit to construct the following work, in accordance with the accompanying plans
and specifications:
Edmonds Medical Clinic, Inc.
WORK— New/Addn................... »....................................................................... ........ Ground Area.................................... No. Storie& ...........
Mr. Jor ensen Architect _ Const Wood V xetght»30'
PlansSubmitted ..."......».............t..".................._.............._....................•"- Type-.................».
LOCATION — Address .»..63...-.. 5th Ave.. So. ........................ ........»._. ....»... Use ZoneC-..:..».. Fire Zone"�..............»
.. .. ...... ..... .....
�ortion of NW 1/t of NW 1/4 of Sec. 25� T27N, R3E� W.M.,t Snohomish County,.Washo
Recorded Lot Bloch ................... Add'n ...... .R...."...%._bQJQ d)......................._......."............ Sewerage.....Seyd................
120.48x120� 120.48t Bldg. Setbacks, - - - -
Lot Area...»... ..._... ...»........... Width ...,......_............... Min B1 Setbac Front and Rear................................ 91des..........._................
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Drs. Shaw, Lichty., Sola Address... 611 - 5th Ave. So. _ ...» Phone.. .
l C__.."...
(Edmonds Medical- »
Plane by.»»91. 4209D ?D........"_...._......».
Address ............................................ » ..._.."..... Phona�
J
R. M. Mattson Soriv "Inc. ............. Adaress.._19124 .-.."92nd W. w............Phone..."pR."8-712„
Bldg. by..».........._..».........»...»...... .............
Plans
Plbg. by. ............. "........ ».......................................................... Address. .......................................................... ........ Phone ..............................
Heatingby .......... ".... _........... _.................. "... ............................... Address................................................................. Phone................................
Elect.by ..................... ...................................................... ........ Address...».."._. .......... ........................................... Phone.............. ...» .
See attached list of corrections
NOTE: Leal»Description (Cont!d.1s Bed."at a point"on the West line of above mentions
property,, 660.00t So. of NW corner thereof; th. E.P 150 ft.; th. So.s 132ft.; th W. 150
"."..."..»..".."._........»...._..».._......_..............................................................."......".._.."......................_..»..".._.._"............_.."..»........._.......»...............
132 ft. to point of beg.; LESS the W. 30 ft. and the So. 15 ft. for Road#
.............._...."..".............._..........".._.."..".."......................_................ ......."........
..
S'i�ua�ecl"'i"n'"Siio'fioriii"sTi"Couri'8y;"Wasfii'iigtoil. -
The above is a correct statement and I agree to comply with all applicable Codes and State Laws regulating the work.
Same as above 3/13/63
Signed: Owner/Agen,(.._.._........................... Address..."... ....... "... _. ............._....... Date .........._..........»..
f.
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the approved p
and specifications and Building Department notations thereon.
VALUATION PLIUM FEES
............... Bldg. .... #A15&Q ......................
Plbg. .... $--J 9.00................_....
APPROVED: Heat .... $.......r ......................
Date.....)//163........................................................ Elect. .... $.... 35.00......... ...........
BUILD G DEPARTMENT Others ...$........................................
1• ��'{ .{ �` ••� �!G'. TOTAL FEE "193.00......................
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NOTES: No work requiring Building Department or City Engineer's inspection shall be covered before inspection and approval.
Twenty-four (24) hour notice requested. Contact the City Engineer prior to constm etion of all site utilities, such as
curbs, paving, driveways, sewer, water and street connections.
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BUILDING "AM
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Appl. No....�-
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CITY OF XDMONDS
Building Depa hnent
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Permit limit, one year
"f AMWCAtION is hereby made for a permit to construct the following
work,
in accordance with the acoom,
and specifications.
Two ants are submitted herewith for approval.
f II parrying plans
new alter �L� Off -St.
Work adds repair ...................
`r''= f n ........................................................ Parking .
� .... Fire zone:
> Occupancy................................ Const. type.. .............. ...... Use zone.....:... ' ..
t
1 u e Lot ................. Blk....................... Addn........................._....
r. �. Address.................................................................... -•�
Lotfrontage ....................................... Area ........................................... Septic tank........................................... .........
Bldg. set -backs' — front... ..... r. side .............................. 1. side .............................. rear....
6—eI0ae �
Owner... Address ................................. Tel. No.....
1l...nn.............................................. y .................
Builder.... ..!k.(/ ................. Address.........1...`..7..:`....%l. No....
Plans; by.................................................................. Address.................................................... Tel. No........._...........:...
•f�
Remarks...................................................................................................................................................... ................
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work.
Signed Owner/Agee j y� .A ddress............................................ Date..t,�-�.....-6/
VA
MMIT 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.
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Valuation ..................... fi-O ..•_..._....................... Permit fee...........P�...� ...... Recd. by....�/........... ...........
.:...
BuildingDepartment, By..... �J�.............................._................... Date.................. ............. _....... .... .....................
NOTE This permit does not cover plumbing, sewer, or electrical installations, nor does it permit any work to 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.
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