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B6lILDING DEPARTMENT
PERMIT APPLICATION
�[",:.. NAME (OR-ltlf.�"09-B{ipitiipBB!' //n
� T� u.� �. U �Wl
MAILtN ADDRE$8
a s= _ Z � o -lnc .�
NAME
i
i 00 ADDREt
FO
Y
w
4
O
q
O7
O
Applicant Fill
Ineido Heavy Lines
wan
e► r
� � ��� �7iaa��'
NEW
RESIDENTIAL
�
LINE
ADD
❑
NON-RESIDENTIAL
HION
'
�
RETAINING
wALL
DEMOLISH
E
FENCz..........Ft.)
ALTER
❑
ORCFILL
�
^
YRE-MOVE
�'j
${VIM
REPAIR
I I
INBP.
' `POOL
DWELLING
UNIT$
T
I
I hereby acknowledge that I havo road this appilcatlon; that the In•
formation given le correct; and that I am the owner, or the duly author-
Ixed agent of the owner. I agree to comply with city and elate laws rogu-
latlog conetructton; and In dalbg the work authorised Waroby, no Dereon
w111 be omployed In Wolatlen of the Lobar Code of the etnte of Waeblagton
relating to workmen's Compensation Insurance,
NOTE: Permit Limit One Year (E:Copt DEMOLITIONS which
shall bo completed�o�nlaety days; MOVED -IN DOILDIN08 shall be com-
ic !n alx m e.
�`w''�
�•. r
CROLL MAP NO.• PERMIT
e�/O J Q� � V�r
��
EXI8TIN6 STREET R/W ............FT.
COMP. PLAN 8T. R/VJ ............FT.
OF
❑ YE$ � NO
�Ai]Y14WfIi4'IMRMd.I,IW.RY�l,(✓VpM,I..-..non
� r
710
REAR YARD BETBACKI
I�
VAOANT BITE
0 YES ❑ NO �
DEFICIENCY THIS PROPERTY
8Y
❑ YE8 ❑ NO
...-...... � O � -
G'.nt�.�. At)�aC..ira�,�l .
Valuation
Pion Check No....
BUILDING
PLUMBING
HEAT & 6A8 LINE
FENCE
BION
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
L��
TOTAL AMOUNT DUE
I
I �' �
I �QZ �]
V
ATTENTION
APPLICATION APPROVAL
TIIIB PERMIT
Thin application 18 not a permit until
AuxaoRlzEe
ONLY TBE
signed by the Building Official or hi$ Dep-
woRe; xoTED
uty; and fees are paid, and receipt is ac-
llnowledged in apace provided.
�TURE OWN OK AOENT) DATE BION D INSPECTION
7� •� � / �/ DEPARTMENT
i%/ s OrrY OF
EDMONDS
NOTE: Applicant Subject to Plan C.beck Fee
PR 6-1107
Thle PernUt covers work to be done on private property ONLY.
Auy eonalevetloa on the publle domain (curbs, sldewWks, driveways,
marQuecs, etc.) will regmre eepnrnte permlulon.
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F/e.� { RECORD OF If�SP
1
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The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating
work.
Signed Owner/Age ....t.5X Address..:3... �'
x �j t 4 ry
�... y
PERMIT for the above work is hereby approved, subject to"the above conditions.' to oomphance with the ap• " r " t `" '` ,
proved, plans and specifications and Building Department notations thereon."
..................................................... Permit fee........... .......... Recd. .
^�.M,
Valuation
by.�.•
Building
Departmcnt,, By. ....._.�/..1?-. .. ... Date ... „
r,
y
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APPLI&JION & WORK PER . as -3
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 plane
and specifications: I
WORK — New/Addn. ............. ` ......:. Gl....
c�X6i'ound Area .................................... No. � Stories .:
Plans Submitted................................................................��........................... Conat. Type....:............ /�.J Height
.,/ — o� — ....... Use Zone.: Fire Zone
LOOATION —Address ..........................
RecordedLot .................... Block ................... Add'n........ Jk/ ........ ............... ......... Sewerage ....................................
'r
............................. Width............................ Min. Bld Setbacks, Front and Rear.:.............. Sides....... /... ... ;
Lot Area.....:.. g•
Owner. fir.. Address.......... Phone..
Plansby........................................................................................... Address............... ......._. Phone ...::
Bldg.b ..... Address.....�a U / 'T.�� �i! •.. Phone......:. ^� /lv�
y...
Plbg. by ............................:..... ......................................... Address.............................................. ................. Phone ...: .......
Heatingby........................................................................................ Address.............. .................. Phone .....:
Elect. by......................................................................................... Address...................................................................... Phone ..:::.
f'
Remarks ........................... ....... „ r
........ ..................................................................................... ... ....... ...... ... ,� :fir
....... .......... .._........ .. ... ...
.... ..... ......... ...... ..........: .. ............... .. ................
L s
........................................
The above is a correct state
Signed: Owner/Agen .......
...................................................................................
and I agree to comply with all applicable Codes and State Laws regulating the work
F
�../.%9 ...rQ6lAddress......... ............... Date .�.
.......
,
'
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the •approved' plans
and specifications and Building. Department notations thereon.
VALUATION PERMIT FEES
t
Bldg. $.. ... ��
..
$..:....9��
.............
Plbg. $....7!
APPROVED: Heat .. $..........
/1........... 1i,�.. fir. Elect. $.....
.
Date..... .......... .........
..
ss
BUILDING DEPARTMENT Others ... $................................
--��JJ
By........................................................... TOTAL FEE $..... ...1...............................I
II.
_
NOTES: No work requiring Building Department or City Engineer's inspection shall be covered before inspection and approval
v; Twenty-four (24) hour notice requested. Contact the City Engineer prior to construction of all site utilities, such
.-, and street connections.
curbs, paving, driveways, sewer, water
1�
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