710095.pdfBUILDING `DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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LL MAP NO.:
PERMIT
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NUMBER
710095
';Pl ° • - .
BACK STREET SETBACK
REAR YARD SE `BACK
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❑ YES
EXISTING STREET R/W ... ........ FT- DEFICIENCY THIS PROPER
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COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
FIRE
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RESIDENTIAL LINE PLANCHNEW ❑ NON-RESIDENTIAL ❑ SIGN
DADD ❑ RETAINING REMARK
DEMOLISH WALL
ALTER ❑ EXCAVATE FENCE
OR FILL (•••••.....x.......... Ft.) O 3C
PRE -MOVE SWIM
REPAIR ❑ INSP. POOL -
DWELLING
UNITS
O G
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 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 State 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.)
i' I TYPE_.2roeONSTRUC
NSPECTOR REQUIRED
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p},NO
UM
Plan Check No .....................
BUILDING
PLUMBING
HEAT A OAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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NOTE: Applicant Subject to Plan Check. Fee
This Permit covers work to be done on private properly ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6.1101
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Valuation Fee
-966. [,6 3, 6_0
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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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RECORD''OF'INSPECTIONS'
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APPLICATION BUILDING PERMIT J APPI. No.'
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OF, EDMONDS Building Department Permit limit, one year
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ATION is hereliy'made for"a permit to construct the following work, in accordance with the accom/
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py'z�Yand specrftcations.' Two sets are submitted herewith for approval
Off/S Parking 1
'ddn repair ....... ....
_.....
Const. type ...........:
Use zone..:...:� . •... . Fire zone .......
f
..... Addn.................................
Lot:.
Blk..........
Septic tank
`fi'��'��. frontage.. .......... .. ...... Area................ ...
r. side ................ 1. side . rear..
Bldg set -backs —�t- .. ..
-
s Address..../.. -A.............
.....
/
Lt. T 1 ' ...................
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v• "'j,�q'-.¢*I r,xvv�•"til +iosrlP i 1 �Sya* i
�/,TCL NO....... ..
�e /.-.......... Address ..................................................
... .... .....
Bu wer (
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{ _ Tel.
I .... .Address
dar s
Y, s 3 Remarks ......... ....
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1 y41:KtXC 3 ! r !f'ur t4 e: f:. 1
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...................................1
.........................
.
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating' this ' I
work. 3
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wner/Agent...............................................
.................... ................ .
Signed O
Address.......... Date.
approved, subject to the above conditions, and to compliance wrth the ap/ y s
PERMIT for the above work is hereby PP #
proved plans and specifications, and Building Department notations thereon.
-�i. ... Recd. by. / ......
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Valuation rz��G?L. ......... .. Permit fee
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.. . Date........ . SaL....
Building Department, y....:�_.
This Permit does not cover Plumbing, Sewer or Electrical instdllations.
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Al TIC' & WORK PERAT
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Application No. /lf ...�...
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 I `
,x and spec
if
s tiRtij;:, Sign
{WOKS -New/Addn................................................................................................ Ground Area.................................... No. Stories............
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Plana submitted ........Earl D. Morris, Jr. ................... Height.. .............. ,
...................................................................................... Const. Type.....................
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LOQATION —Address ....106...-...4th Ave . W•.................................................................... Use Zone. C' 1.......... Fire Zone.... .......... i
W. 95� of Lot 12, Hlk, 1, Plat of Edmonds
, Recorded Lot ................... Block ................... Add n.........................................................................._..................... Sewerage .................................... t,
4
4 LoL Area...... Width ............................ Min. Bldg. Setbacks, Front and Rear................................ Sides.........................
Alex Kuzmoff hth and Main
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•-� Owner........... �................. Address.......... .... Phone......... ,.
Pia
E. D. Morris, Jr. - ....
743 o2lib `
Plansby.....:................................................................................. Address........ 173�?.........72nd ...... .................... Phone......... _ .. ,
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Bldg. b Address ................................ ........................ Phone................................
4,N g. y..............................................................................4
Plbb ........ Phone ................................
gy........................................................................................ Addresa................................................................
.T, i
Address..................................................................... Phone.........
. Heating by............................................................... -
Elect. by....................................................................................... Address ........................................................................ Phone.............. ........... 1
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Remarks........................................................................................................................................................................................
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................................................................................................................. 5 1.
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.....................................................................................................................................................................................................................................
The above is a correct statement and I agree to comply with all applicable Codes and Stata Laws regulating the work. �}
Signed: owner/Agent— .... /dress ............................................
Same Date.:519163 k' r
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. j-
VALUATION
PERMIT FEES 1
..� a � rtr
o.. $..
$. .............. Bldg. f
Plbg. .... $........
Heat
APPROVED: $.... ........
.. �r.?... $............! '
Date........ ........ ............................. Elect. ..
j Y;.
BUILDING DEPARTMENT Others ... $...................101
TOTAL FEE r
By....... ........................i'......... ........................ $ �.......... ..............
NOTES: No work requiring Building Department or City Engineer's inspection shall be covered before inspection and approval. t
Twenty-four (24) hour notice requested. Contact the City Engineer prior to construction of all site utilities, such as
curbs, paving, driveways, sewer, water and street connections.