710167.pdfE
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BUILDING DEPARTMENT
Applicant Fill
PERMIT APPLICATION
Inside Iieavy Linos
NAME
04(+ eLES A, o N C A-(J
MAILING ADDRESS
�og2S —gam LJ
CITY
TELEPHONE NUMBER
EDt--to tJDS
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NAME
yUj
ADDRESS
F
CITY
TELEPHONE "UMBER
NAME
C4
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ADDRESS -
67
CITY
TELEPHONE NUMBER
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ROLL MAP NO.:
PERMIT
NUMBER
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IETBACK { STREET
SETBACK
71016741,
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REAR YARD SETBACK
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VACANT SITE
❑ YES ❑ NO
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VARIANCE NUMBER
;f
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
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REMARKS �
Legal Descripllon of Property (Show Below or Attach Four Copies) -
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TYPE CONNECTION I VERIFIED BY
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PERC. TEST I PERMIT NUMBER (p
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W REMARKS m {
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FIRE ZONE I TYPE OF CONSTRUCTION I STREET IMPROVED
REEO!
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SPECIAL INSPECTOR REQUIRED (OCCUPANCY GROUP j
GAS ❑ YES ❑ NO
❑ NEW RESIDENTIAL ❑ LINE PLAN CHECKED BY
NON-RESIDENTIAL SIGN
ADD ❑ DEMOLISH WALL KING REMARKS
ALTER ❑ EXCAVATE
OR FILL u (.......... x.......... Ft.)
❑ REPAIR ❑ PRE -MOVE SWIM
NUMBER OF STORIES I NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE Valuation Fee Receipt No. )
Plan Check No .....................
J BUILDING
PROPOSED USE
PLUMBING
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aPLOT PLAN (Indicate Building setbacks, abutting streets) HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL 11
N
1 SWIMMING POOL
DEMOLITION
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PRE -MOVE INSPECTION
EXCAVATION OR FILL
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TOTAL AMOUNT DUE �,Dv �!, l
I hereby acknowledge that I have read this application; that the In- i
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- ATTENTION APPLICATION APPROVAL
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 THIS PERMIT This application is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Official Or his Dep-
ONLY TILE ut and fees are paid, and receipt is ac-
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED y,
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com- knowledged in space provided.
pleted In six months.)
SIGNATURE (OWNER OR AGENT DATE SIGNED INSPECTION DIRETU LE
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A I �i. DEPARTMENT
' 7/ CITY OF D T12-0
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 0-1107 � _ 77/
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, FILE
marquees, etc.) will require separate permission. {
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APPLICATION .UILDI�I PERiNiT E Appl. ;vo:.:f
f CITY 'OF "EDMONDS Building Department Permit tunic, one year
APPLICATION is hereby made for a permit to construct the following work, in accordance with the accom�,
panying .plans andspecifications. Two sets are, submitted herewith for approval.
((' ` new,. alter Off -St.
Work addn repair r� ,: .� ....... �-<- :�-r................_. ...--. ......... Parking _._�.._.
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• Occupancy, ...... ........ Cgast. type B� ... .............. Use zone...... ....(01T... Fire zone.... _._ �-
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Address .--. �r' ........,y a �.i t +Blk :. Addn `�J y.
.................... f �-.i r_ ♦ = .................... r f�...n.rRi abQ:f
t.. Lot fronts e....._ r _,k..� � .5 ...... Area ....................... _ r > i
j g �`...... .--•--...._. Septic tank..._.._!„.�'.�............ .......
l; Bldg, set -backs front ..... ............... r. side............. tea?........... 1. side... t�_) .... . rear..........
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{ Owner.r'�.r!'` r`..:. _ Address..._'.%..... L..Tel.
1 Builder.. ......., Address. .... ..............................: Tel. No.... .......................
Plans by. :Tel. No:.. ......... Address.
Remarks......... ............................................................. .............. .
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work.
` .�DateSigned Owner/Agent.�%/ .. Address .._....... ...•. .-
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. -
Valuation ................(_!7._ 1a2....._... Permit fee........ .' :......._.. Reed. by ....... 1....._.. .:...
Building Department, By ......_.................... Date...��1.__...�r
k' INSPECTION . RECORD
} :.. Fdn, OK ..........
.................................. Frame, OK .................................................... Final,` OK ............................ .........
Y This Permit does not cover Plumbing, Seuier.or Electrical installations.
t.., .._.:.�. ..�.....�_..1�v....t.._'x..�u'+�...L�...•..-'....•....,..u.nL�::.t........•.+.wl:.,.�...._......a._.._:.....�.w�.:....w...,.u:..�.�ti-_..r1>. ,'��
APPLICATION BUILDING PERMIT
CITY OF EDMONDS Building Department
Appl. No...��... `
Permit limit, one
APPLICATION is hereby made for a permit to construct the following work, in accordance with the
panying plans and specifications. Two sets submitted herewith for approval.
new• alter !LOff•St.
Work addn repair . �
Parking ............. -;
Occupancy .............15t........... Const. type.......... -r.-� ..... Use zone....'°.. . _ �T 1f ....... � _ .._. Fire zone....,._. ......�._...
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Address....z2i./...o ....... � L! ... Lot .........: ......... Blk....................... Addn............................. t
Lotfrontage ........................... _........... Area ......... ......... ........... Septic tank..........................................................
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Bldg. set -backs — front......... �'..... r. side ........% �'........ 1. side .......7.... ........... rear --.. �.J�..................
Owner.....1�..........a �1. No... Cl..�.�� i
Builder.................... ................... Address.................................................... Tel. No .............................
Plansby .......................... ......... .................. Address.................................................... Tel. No ............................
Remarks..................................................................................................................................................................................
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work.
Signed Owner/Agent.c 6 �0 ti�....... Address ............................................ Date . :�....... ��
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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.
Valuation ...................... Permit fee ....... ?..8 .............. Recd. by..4-ro''. !/...>f..
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Building Department, By ....................... ............._................... Date.....�...... .........................
INSPECTION RECORD
Fdn, OK ............................................ Frame, OK .................................................... Final, OK .......................................
This Permit does not cover Plumbing, Sewer or Electrical installations.
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