710576.pdfBUILDING DEPARTMENT I Applicant FM
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
MAILING ADIMES111 ?
CITY winmurnuam N MB•
AC JAM d s 1-74-3 -/08
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d Description of Property (Show Below or
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wSI7 Dfr LOT 4' ke..r- 04� SYIO .
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NEW
RESIDENTIAL
❑
GAS
LINE
❑
NON-RESIDENTIAL
❑
SIGN
ADD
NG
❑
DEMOLISH
❑
WALL
ALTER
❑
EXAVATCE
OROFILL E
El
E. Id.. x
((........Ft. )
..........
REPAIR
^l
I
PRE -MOVE
INSP.
L-{
SWIM
POOL
DWELLING
UNITS
z
0
G� PROPOSED USE
Q PLOT PLAN (Indicate Building setbacks, al
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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 authortud 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 BUII.DINGS 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,
nwquees, etc.) will require separate permission.
C
NO..
_11N
PERMIT
NUMBER
6 I LOT AREA VACANT SITE
S C3 NO ;
wRiunrn
STREET R/W i
EXISTING STREET R/W iom. DEFICIENCY THIS PROPERTY ,
...... j,�.I
COMP PLAN ST � R/W FT. FT. p
REMARKtriveway slopes not to e.;deed those —
indicated on Standard Drawin,';k 103,11
PEAMI N� M ER �
m
INION STREET IMrP�RROVED
iSTRU in YES Q�I10
urxvi.aL mtjrNL7A:vn AUIiVulrLeiu vuuur"Ux �u 9
[I YES NO
PLAN CHECKED : i ila JI I L IS LO ATED IN THE
CITY OF EDMONDS. I.C.M1
REMARKS TAX SHOULD BE CODED s1.04:
Valuation
PlanCheck No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
Fee
Frol
:ad
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHOBIZF.S
signed by the Building Official or his Dep-
YTHE
WORK NOTED
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
DIRE R'S a TURE
DEPARTMENT
CITY OF
Dw E
L�
71
EDMONDS
PR e-1107
FILE
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APPLICATION
CITY OF EDMONDS
u ,
BUILDING PERMIT Appl. No...7... -...a ...
Building Department Permit limit, one year ,
APPUCATION is hereby made for a permit to construct the following work, in accordance with the accom•
panying plans and specifications. Two sets are submitted herewith for approval•
new alter Off -St.
Work addn repair ....................... .:..............._............... Parking ........
'e.... ...... _...........................
Const. a Use zone_ �_��......._ Fire zone ..._.__:.
Occupancy:. type ...._.....
/05� - ... Lot ........................ Blk.......... .....__.. Addn......................................
Address ...........................:...
Lot frontage.... .. Area ........................................... Septic tank ......... ......._. ......... ..........
Bldg. set -backs — front ........................... r. side ......_.. 1. side .............................. rear................................
.............:. ................
Owner .. .... Address. ........ �ze4el. o U..::.:
Builder ..........:... �tX/•__.... Address .................................................... Tel.. No
Planaby.......::... .:_.._...:. ....... ..................... 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
t_
Signed Owner/Agen Address ...
. Date.,c
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.
.._........ Permit fee ................................ Recd. by.....:........ -`�.......
Valuation ...............:. / ,........ t � ,!I
Date._... ..:..........
Building Department, By... _ /3""'
1.
This Permit does not cover Plumbing, Sewer or Electrical installations. t`!
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