710301.pdfz
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UILDING DEPARTMEN
PERMIT APPLICATION
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NEW
ADD
ALTER
REPAIR
51
0
or
Applicant Fill
Inside Heavy Lines
RESIDENTIAL GAB
LINE
NON-RESIDENTIAL ❑ SIGN
DRETAINING
DEMOLISH
EXCAVATE FENC
OR FILL
PRE -MOVE swim
I l INSP. ' ` POOL
DWELLING
UNITS
I hereby acknowledge that I have read title application; that the In-
formation given in correct; and that I am the owner, or the duly author -
load agent of the owner. I agree to comply with city and state laws regu-
lating construction; and fn doing the work authorised 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.)
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.) win require separate permission.
C
NO.: PERMIT
NUMBER
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
TYPE
❑ YES ❑ NO
Plan Check No .....................
BUILDING
PLUMBING
BEAT k 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 6-1107
REAR YARD BETS
VACANT BITE
❑ YES ❑ NO
DEFICIENCY THIS PROPERTY I I
DR � :I
STREET IMPROVED
❑ YES ❑ NO
SOUP
THIS SITE IS LOCATED IN THE
TAX SHOULD BE CODED 31.04. 1 1
Valuation
00 — I � t-
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.
-' '
APPLICATION LBUILDIN6 PERMIT
CITY OF EDMONDS Building Department
Appl. No:. o?,p — 4 �-
Permit limit, one year
APPLICATION is hereby made for a permit to construct the following work, in accordance with the aceom•
parrying plans and specifications. Two sets are submitted herewith for approval.
new alter
Workaddn repair..............'.......................................................... ..... tg ......................
.9d
Occupancy................9............... Const. t
Address. .. .0------- /�
Lot frontage ........................................ AJ
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Bldg. set -backs — front ............................ r. side ............................. 1. side .............
Owner............ ..:... ...................... Addrese......��....� e ..=
Builder .............�.......:... Address ....1r� v� 5....�....
.. Fire zone ............................
.......... rear...
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 ..... _ ..............
Address ............................................ Date-4�).:' fO
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.
. / e-o
Valuation ............. : 0 0.... P.............. Permit fee........ a................. Recd. by....�`�- .... ............../ ,
Building Department, By..............%.Cf. . ............................................. 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 officia grades of streets
and alleys, and plans for future sidewalk development.
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