19780343.pdf9
USE PERMIT
BUILDING" DEPARTMENT Applicant Fill ZONE ry� NUMBER 780343
PERMIT APPLICATION Inside Heavy Lines JOB
ADDRESS
NAME (OR NAME OF BUSINESS) 1115 1 4--
LEGAL LOT LOT AREA SUBDIVISION NO.
r YES NO q 4B Ord- jqoQ nuep
W MAILING ADDRESS 4 )*;EL
z Z1.) -- STREET R/W
I (') V3 s-v EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
0 CITY TELEPHONE NUMBER COMP. PLAN ST. R/W (90 FT. r6 FT.
I1_%-1'h t-) REMARKS
NAME
MSTAIC)
U 'LL CHECKED BY
ADDRESS
0
STREET AND/OR UTILITY WORK R/W PERMIT REQUIRED
CITY TELEPHONE NUMBER REQ'D.
< *YES ONO 21 YES ONO
UNDERGROUND
NAME WIRING REO'D, 10 YES ONO
M TYPE CONNECTION IRYFS IVERIFIED Y
0 ADDRESS SANITARY SEWER
U El No Ilk
-C SEPTIC SYSTEM YES PERNPT NUMBER
It CITY TELEPHONE NUMBE APPV'D BY CITY ENG.
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z ONO
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U STATE LICENSE NUMBER U-1-T—Y-LiCENSE NUMBER REMARKS
METER E BUILOTG SUPPLY SIZE
Legal Description of Property (Show Below or Attach Four Copiesi
1 -7. ) Y-2,
WD REMARKS
Z )Pw��NX, L-50
5 S P d)�Ikj� Aw�� SIGN AREA SNV. REVIEW ADB NO.
L
i ALLOWED PROPOSED CO P ETE LEXEMPT
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09
KS
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.J AIN RIANCE OR CU PLANNING RE I B ATE
IF 5 A 4
ARDS LOT COVERAGE
00Y -r%
FRONT S?D* Ja;k"
Er NEW RE DEN TI G FIRE ZONE TYPE OF CONSTRUCTION ICODE HEIG T
NON-RESIDENT 1 1 .-'97 / #r - / 7 �7 3 3
El�W� ETAINING SPECIAL INSPECTOR A EA 1A I OCCUPANCY OCCUPANT
DE 'X GROUP /
MOLI LL REQUIRED LOAD
MOL
ALTER EXCAVAT F NCE 0 YES N 0
El OR FILL (_ X_ PLAN CH KED By THIS SITE IS LOCATED IN THE CITY
PRE -MOVE swim 'i OF EDMONDS. LOCAL SALES TAX
REPAIR INSP. El POOL REM;(RKS SHOULD BE CODED 31.04.
NUMBER OF STORIES NUMBER OF
DWELLING p,�4S;r/C DAIV A1007-
3 UNITS
NATURE OF WORK TO BE DONE
"�v IN .54-r u -+(&rl
VALUATION FEE
PROPOSED USE PLAN CHECK
z NO. 23
0 A-p4-ry-_rnqq+-s 0.
P ______r__DICATE BUILDING SETBACKS.
a. PLOT PLAN IN
E ABUTTING STREETS) BUILDING 50, 49b 3 &3
U
th PLUMBING
M HEAT & GAS LINE
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FENCE
UU /6�/v
MPLETE SIGN
RETAINING WALL A )ao4oz�_0
I —SWIMMING POOL 1/1710h e�
I hereby acknowledge that I have read this application; that tile ill -
formation given is correct; and that I all, tile owner, or the duty author-
ized agent of the owner. I agree to comply with city and state laws regil-
lating construction; and in doing tile work authorized thereby, no person
will be employed in violation of tile Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE- Permit Limit One Year(i-xcept DEMOLITIONS and FILL
PERMITS without conditional use pCTIIIit, WhiCh shall be completed in 90
days; MOVEJAN 13UILDINGS sliall be completed in six inotiths.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
NOTE: ApplicanrSubject to Plan Check Eee
AL AMOUNT DUE
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit
AUTHORIZES until signed by the Building Official or
ONLY THE his Deptity; and fees are paid, and
WORK NOTED receipt is acknowledged in space pro -
INSPECTION vided.
DEPARTMENT D I RECTPJJ;S� S
CITY OF /n
EDMONDS DATLE �j
775-2525
This Permit covers work to be done on private property ONLY. ORIGINAL - File YELLOW Inspector
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission. GOLD - Assessor PINK Owner
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