710203.pdfit
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;;;BUILDING DEPARTMENT
PERMIT APPLICATION
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Applicant Fill
Inside Heavy Lines
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TELEPHONE NU
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IF
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Pita
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❑ NEW
ADD
ALTER
REPAIR
or
ID RESIDENTIAL
R
GAS
LINE
NON-RESIDENTIAL
❑
SIGN
❑RETAINING
DEMOLISH
WALL
EXAVA
®
PENCE—
OROILLFTE
.%5_260 ..Ft.)
PRE -MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
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.)
�uQD
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission,
C.
�A
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
❑ YES ❑ NO
4 �
G
Pian Check No .....................
BUILDING
PLUMBING
HEAT d: GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR g-1107
r
PERMIT
NUMBER 710203
❑ YES X] NO
DEFICIENCY THIS PROPERTY
❑ YES ❑ NO
m�
Gov
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.
DATE
FILE
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Y' •C�
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MOR0 BUILDING PERMIT
iIONDS Banding Deparhn t
Appl. No...... m, 3— !o �
Permit
limit,
one year
PLICAIION is hereby made for a permit to construct the following work, in accordance with the accom-
lags and specifications. Two sets are submitted herewith for approval.
..
alterOff•St.
repair................................................._......................................................... Parking ........ _.._.......
Occu anc Const. type....... ....... Use ne........ Fire zone ...........................
z
dress ..a�./�•• — :.4. Lot. ...... .... /........ ...... .......... Addn........................ .
7 5:....A.Y.�'
I:o!' frontage ...... ........ �C....._.. Area ............................_.............. Septic tank........._._..........................�..............
... y
Bldg: setbacks —front..........' ....... r. aide ......................... . 1. side .. /0 . rear............ /`� �....
`.r�:c..�.... Address..'/..o//..........e
owner. ..i..,l.. ...._. .3?o t5
i .
Builder.'.:.....-.-nQ.Q....................... Address......................... ..................... Tel. No .............................
,5
n Address..
'Plana by.. ...............................................................Tel. No...........
. ..... ..... .... .......
t1�il.l1 �S y 1
Remarks.:. ................................................................................................................................ ........................
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work
Signed Owner/Agen Date.........
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 ............... ..li.......... Permit fee....... ............ Recd. by........�..�C.l%-c* �`,f . .......
Building Department, By ..................... ............... _................... Date......4 -may' ..:.� y�... ..........
INSPECTION RECORD
Fdn, OK ............................................ Frame, OK .................................................... Final, OK.......................................
This Permit does not cover Plumbing, Sewer or Electrical installations.