670169.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy LiDes
NAM (OR NAME OF BUSINESSI �
J. 1110a M's
MAILING ADDRESS
S_/9919-88,4ye
t
If
PInnA IT
NUMBER
;U 169
/ 7 Z / Y= 6 y I&,
13IDE YARD 'SETBACK STIIEET SETBACK REAR YARD HEWBAUK
USE ZONE LOK AREA VACANT SITE
A 111 — 9 0 YES W_<O�
I 14RICIRT I BUILDI AlUILA. I VARIANCE NUMBIUR
ese ption of Property (unow Below or Attacit ifour copies)
I I J- W-fec-19 _r0wo5h1�-1-2A4K'
c.
—
RCI�74ew
REMAI
/ J? LO
V
It
FIRE 2
ov'ze'op'�kjed
L
SPECLI
C
[] YES
FL_&N
E] U
fK NEW RdIDENTIAL A
NON-RESIDENTIAL 8101:
0 ADD Ll RETAINING
F� DEMOLISH 17 WALL
MALTER EXCAVATE PENCE
F� OR FILL ( .......... X .......... Ft.)
REPAIR PRE -MOVE swim
1:1 INSP. POOL
RE
NUMBER OF STORIES
0" e_
NUMBER OF
DWELLING
UNITS
NATURE OF WORK BE NE
0 no YtC7
_ ep_ W&P
;-STREET R/W
FT. DEFICIENCY THIS PROPERTY
............
PLAN ST. R/W
............ FT- .......... FT.
8
—CHECKED
5
0
Z
1 By
RZE SERVICE
SI2M CLEARANCE
BY
ICHECKED
B
Iola ro C7 -k c4e C Plan Check No .....................
PROPOSED USE BUILDING
eve ('Cpr- q(qra�&�
Q PLOT PLAN (Indleeto Building set0adits, abutting streets) PLUMBING
HEAT & GAS LINE
El: PENCE
t SIGN
Lo
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given to correct; and that I am the owner, or the duly author-
Ized agent of the oivner, I agree to comply with city and state laws regu- ATTENTION
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 THIS PERMIT
relaUng to Workmen's Compensation Insurance. AUTHORIZES
ONLY TItE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed in ninety days: MOVED -IN BUILDINGS shall be com-
pleted InAtz months.)
I SIGNATURE (0 ER A DATESIGNED INSPECTION
DEPARTMENT
CITY OF
AV== EDMONDS
NOTL -Applicant Subject to Plan Check Fee PR 6-1107
This Fermlt covers work to be done on private Property ONLY.
Any construction on the public domain (curbso sidewalkst driveways,
marquees, etc.) will require separate permission.
Valuation
[] YES Z-N,5,—
k. C. e) 01, 1
No.
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.
FILE
T
I
I
A 11, that portion of the Northeast quarter of the Northwest
cuartcr of Section 19, Township 27 North, Ranpe It Ea--U)
k-1. �1. dn5cribed as follows:
13C.-t.-i.nninn at the Southwest corner of said subdivilsion; and
L!.-I n i n F_,, th nc'c *North 10321210 West along -the West line of
Ioid subdivision 85 feet; thence Morth 89101112011 East lb 70
L(�ct; thence South 1032'23" East 85 feet to the South line
0 (1 nubdivision; thence South 89004120" West TG6.70 feet
to tlie. point of beflinning.
EXICTII'i' the West 20 fect and the South 20 fent thnroo.i i0v
known as, a portion of Tract 112 Haplewood Oardems,
an unrecorded plat) .
Parcel (b)
That i)ortion of Northeast q*uarter of Northwest quartea., o.'*
Sr_�ction 19 , Township 2 7 North . Range It East , W. M.
clescr'ibc(l ca; follows:
at the F')outhwest corner of naid. Northeast quartur
of.' Nortliwo!.;'t cluarter; thence North 1132121111 Wast -,ilon)1, !.,I e st
'IJAIC! 01 85 J.'ect; thence North 119110111"10"
with Sow',.-h lin(,- of said nubdivi,ioii �j dis.tance,
Oi. '20 to Tmw poilit of bef,inning; thonco continue North
l.:ci:-,t 1116.70 feet; thence North 1132123" �t-Jcst 68
thence 'South 89004120" West 1116.70 feet; thence South
111 "j'2 12411 E'asvt G8 feet to point of beginning*.
(Also known as a. portion of Tract 42,, Maplewood Gardens,
an unrecorded plat).
All S4j:UateCj in Snohomish County, Washington.
1 4
I
Date 9— AUG 3.11967
I, THE UNDERSIGNED, BEING THE OWNER AND RESIDING AT SINGLE FAMILY
RESIDENCE, ADDRESS OF WHICH IS 19919 BOTH -AVENUE WEST, DO39 HEREBY AGREE
TO THE rOLLOWDIG:
For and in consideration of the City of Edmonds issuing a building
permit for addition and remodeling of said residence; and in
consideration of the City of Edmonds -not requiring in connection
with this building permit, additions 1�or,alterations to the existing
septic tank drainfield, I HEREDY AGREE that the City of Edmonds
o-time makeimpections on
Engineering Department may from time-t
the premises relating to operating conditions of this drainfield.
4A
I FURTHER AGREE that if faulty operation of the drainfield occurs,
prior to the availability of sanitary sewers, I shall correct said
faulty operation as may be required by the City of Edmonds.Engineering
Department.
0
r 4
I
Ir
4
41,
.
p
I
41
r.-L
0 L
4, 1