710575.pdft;--�-..:..._. � BUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lbles
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WAI.�L NINE
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REPAIR
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PRE -MOVE
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SWIM
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I hereby acknowledge that 2 have rend this aDDllcatfon; that the !n-
[ormatlon given le correct; aad that I 6m the owner, or the duly nuthor-
Ised agent of the owner. I agree to camD1Y with city and etato laws regu-
lating comtructlon; and 1n dolog the work authorised Wenby, no Deraoo
will be emDloycd In vlolatloo o[ the Labor Code oL the Btnta of Waahington
relating to Workmen's ComDenentlan Insurance.
NO TES Permrtl L',mi y0ne, �oaf���esolinurae a�Nbe comh
pleted !n als menthe.) _ _� _-^- T^
NOTE: Applicant Subject to Plan Check Fet
TWe Permit coven work to be done on Drlvate VropertY ONLY.
AaY eooat��ueesn etc�IDwln re7al�reaaeDnnrate permle ion drlvewaJe.
� YE8
NO
Plan Check No........
BUILDING
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PERMIT C•-,�
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IAOK REAR YARD BETHA
IVAOANT �TE
p YE8 �No
REp I VAIBIANCE NUMBEI
DEFIOIENCY THIS PROPERTY
/`/�G
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STREET IMPROVED
� YE8 ❑ NO I
CITY OF EOP�10AfDS. KCAL
PLUMBING
BEAT h 6A8 LTNE
FENCE
BION
RETAINING WALL
SWIMMING POOL
DEMOLITION
PttE-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
TIIIB PERMIT
AUTBoaIZEa
ONLY Till.
WORa NOTED
INHPECTION
DEPARTMENT
OITY OF
EDI4IOND8
PR 6-1107
Valuation
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APPLICATION APPROVAL �'� �, �
This application is not a permit until �,; ,`
signed by the Building Ofiiclal or hie Dep- �:
uty; and Lees are paid, and receipt is ac- '-` :�
knowledged in space provided. �
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APPLICATIcr+I & WORK PERMIT
Application No a.i� f+
;., CITY OF EDMONDS Building Department Permit Limit, One Year
;th APPLICATION to hereb made for a per mit to construct the following work, in accordance. with the accompanying plans
and specifications:
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'"'Ltn^'`Si, O1gLS ................. ...:.............................................................. Ground Area ................................... No. Stories.........
� �'-PId6ns,�SiibmItted r ....
.......................y.....-''�::C..�:4���r�Conat. Type.. Haight...
LOCATION — Address............�......................... t.............. Uae Zone............, Fire Zone... .
e-&ded Lot ........ ........ BloclL ................... Add'n............................... .......................................... ....................... Sewerage................... ..........
"k + Lot Area. ......... g• 1..
............ .... Width ............................ Min. Bldg. Setbacks Front and Rear ................................ Sides..............................�
k0gwner..... ...5 .... .......................................................... Address..` ` ......................... ..: &/ Phone........................ .
s " " ` ' ''•:; y x <Plens by.. ........................... Address............................. ...: .... Phone ..... .....
Phone
Bldg. by. ............................. Address.................... ......................... k
r '
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Plbg. by.. C................. l J!`'GC Iv�!?/Addresa.(a...�..Q .' 1�...:/.� w t..:. P oh n8 ....
Heating by ................ ..........:...... ................................................... Phone
} Address:.
............. Address ................................................... ..... hone................................
Elect. by ......
P
t
Remarks......................................................................................................................................... ... ... ... .........
z�x yi y r t 1,................................................._.............................................................................. I
..............................................................................................................................................................:....... ...... ..
r. 1
......... ............. ........................................................ ........ - . .... ..
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The above is a correc ent and I agree to cc ly with all applicable Codes and State Laws regulating the work.. ;
Signed: O>s=/Ag ...............`'�'••1..................ress .......... ........ ................................... b
_ 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 .,
1 $..1.•r..Q.O.Q....\G Bldg. .... $..........�...
APPROVED: Heat ....$........................................
r
pate...... ...:.................................:....... Elect. .... $............ .....................
BUILDING DEPARTMENT Others ...$........................................
WM., lIerber- . Bldg. I p.y � �
By.................................... _............. TOTAL FEE $,Q..�.................
NOTES: No work requiring" Iding Department or Engineer's inspection shall be covered before inspection and approval.
Twenty-four (24) our notice requested. Co act the City Engineer prior to construction of all site utilities, such as
curbs, paving, driveways, sewer, water and street connections.
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