670171.pdfg%- nenAnTincuf
POSTED ON KROLL MAP NO.: MIT
. - I =BER �_ -7n i
0 U I L L01 111% Applicant Fill
Inside Heavy Lines
PERMIT APPLICATION JUB ADDRESS
NA,KE (OR NA.ME OF BUSINESS) (7
, 0 � - y . � - 6 /-, C/
14 MAIL&— �IA
Zo
JL
lilo Cr d V/6 q 17 1 [---" P) 'C-
�2�- t�//, e? �/ � c �- c?
ADDRESS -at_ e,7 tA
q j-f /" 4
TELEPHONE NUMBF,
"h
Legal DesCrIpIlOo. Or eroperty (Bnow Below or AttaA
A ),o-/- '�? -'� A e- r� _�'
0 da
(7h t1ho k;.w
NEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
ADD
SIGN
DEMOLISH
RETAINING
WALL
EXCAVATE
PENCE
ALTER
OR FILL
( x Ft.)
REPAIR
1:1
PRE -MOVE
INSP.
Ej
......... . ..........
swim
POOL
iUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
TATURE OF WORK TO BE DONE
/ T, [)�
0 YES 0 NO
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. RAV ............ FT. .......... IZT.
[] YES
E] NO
CheckNo .....................
PLUNMNG
HEAT & GAS LINE
(7 FENCE
t SIGN
RETAININd 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.
lzed agent of the owner. I agree to comply wIth city and state laws regu-
lating construction; and In doing the work authorized thereby, no person ATTENTFON
will be employed in violation of the Labor Code of the State of Washington THIS PERMIT
relating to Workmen'n Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITION's which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
31GNATUR9_kQ ER OR AG
:EN DA E SIGNED INSPECTION
DEPARTMENT
CITY OF
EDMONDS
N04: Applicant Snbject to Plan Check Fee PR 6-1101
This Permit covers work to be done on, private property ONLY.
Any construction on the pubtle domain (curbs, sidewalks, drivewu7s.
marquees, etc.) will require separate permission.
LMAX�01=
Valuation
WA
3
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.
DIRECTOR*S SIGN�A
6;�
FILE
A �� A -� �P,4 A
A" A
A A A A I I I A P I A A A A A
A A A , I A P A A A A 07� :
A: 1. - A A A A I A .1 A A A
� I I A A, A I . I , I A AP A A .1
A I A A A 'A A A
f I A
.4 A A A A A, ,A A A A
A A I A A I
t
A
I A I A A A A PAA
A A A A A
I A -4
A I t, � . I . ..P,A A. L . . PA
Pr A A A 4 A A I A A " A� I
> i A 4 '. ; , 1 P� , , I , I A
A I A
IPM A I A 5, A A I A A A A L L A A A A I A I A A A
A A � A A , . A A
L k A L A " ' 4 A A
A� e Poe L A I L
I A " - A L A A A
Pool/ P. 12 1 A
A A or, A � , 4 A _ , I . Z 0 A/ ..." I , A 4 1
1 A I . r I I I
I A A Pie A L L A A
A A A A A
A A
A A A A
A. A 1. A L 7 A A,� A A L .1 A I- A A L L A A
AP Ai AAAAA A A A A I L A A L
A
'AAA 0 7 04 A L A A
0 -A
A A I
A A 4 A 1, % 5
A A A � - ;
I A 1, L, A A A A I A L A A A
A I I AAA A A A
A A 4 A A AAL A
I
A A I I A A A
A A A
, ;. I A A A I A AP I
;A .. A A t d I
1'
A A A A A A A I I I I I A A' A , A A
f, P4 A I A A A P, L
11.4 A A I A 41
P( �;L A
A, I P, A A A A
A A d A
A
A t A A L
A ",�,W;,PAPA A p A A A A I I A I A I I L� I A A A A
A A A A A A A A 4 A V� A
A A A "A A A A
to A I
A :�
A Z A
L A I A I A . A
A I I I A L L
I A A
.A V;P A A A L L A L
A I I :� : A , A I
'A, APPA L . A A L I A
q V-� � , - A A A I
A �, vAj A - A I I L I A A I A A I A
I A I I
N�f A L i A A I +
LL A A + A
Al I I A A A A L
A A A I I I I
L LAP A L A -'It
L' A I
1�0"Pt' "AA� �APL P, L A I I A
A , . , A A A I I I I A A
A A A L ) t A L A + A A A A t
I AL A 4 . . A A A A A 'L
A A L
A A PPA A , A A A A A � _ I A . L A A A A A
A A A + A P A A
I L LLLLLLLLLLLLLLLLLLL A A A A
A + A A A + A A I I A I I I A A A I A A A I I A A A A L A L A P, A A A A A,
d A, P, i I . A
AP I . . I 'I A� . _ A . . A . .. A A A A L A A A A I A
t 11 1 � I I � I A ,, - I I A A A I A
A PAPA, A .1� A I i IIA. i z P.I.,i I PP A. PPP`A I . A - rt . . . A A A L A A
ov j Al `P, 'L j 7 A A A A
or 1, A L A A 'k.� ,A PA. L A o4 I
A A ) , A I A A L d I L I I A A I L A
I A, A ,A A . A A A I i A A
A It J�1, LC A A "o -14 At A I A � d I A I A t A A I L A A A A A I I
-1 A 41 1 1 . A L
A PP A A 1AT , L 'I A', ��f . . . . A . A . A I A A t A I f A A
A. 1A . .1 f k A I A A P� A A 1, f A! A I L L
4tj., ... if 11 A ) , A P, A, 1, 1 1 A I +
XPtj�' , . 'L �`. A A A P I I A - I A I
I 1 4 A A A A A A I A A A 0
A 4 r A A I A A A I , I
4 q I , A � . A . L A A 4
�Akj.,� P.J A A L I
A 'I #� : I A A I . A L A A A I A A A
_ I , V_ , A A rL f, . A d r L A A A I r A A
A . A A A A
AAP� 4 d " k - .4,.-;P� � f ;�, , A, A PAP� �v I,, z P. Wo, I A A A 4 A P 4 P? , - A r, r A P A A A
R�'j or AM 'A' A I A P� ; t A I A P' L
A �' ��; % �j , - f t-,00v �A_ A A. L�, A A A, 'L ; A r A P
P�Ia� L,L"" 'PoP %'AA_ A , I A A A
Ake, y APIA A t I I A L I I r A
pf I A . 5 . i. , A
I A, "IPg " A � , , I A r A A A A 11
I i , 1 1, , A A.- 4 ' A A I A` + A . A � j - A . I I L A
'IA � PA I I �,� � �f A I A .�, To, A A I A A, A, A A P0 A A r A A A A A r
AN , I �;11 A A . . I L " " A . A I + A A A
I AA AL�� A r A 1,P, e'r S A I A A'. L, " t' A r I -L' r- t A A jr A A A .1 1 1
� ;L A A , A A A, r- A Al A A
t A I r A I A .4 PP 4 cPbm', A t r A A A A V r
I d t �P'A,k Kt r, . . A A . A A A r A L A r 11 A A A
A A A A
A P . L I
A A A + A A A
A A 'r P, A L f L A A A A A A
A A A P. P�AXE, A A A L A A A A A A A
A "ALP,j 11 A A
0, A Ar A A r, A A I A A LA + A
A 1, 14 L , ;", '. -Poo r P AP. �'AL r r L I A A A L' I
- 4�4j� AP A PAP A : , I : I A A A A A A A I I A I . A A
PAPA 4,V Po LIP?, t, A 1 A A � ". . " , A 4 A A A
1. P. tIJ7,4 I . ". , P, � to _AA, ' A A A L A r
o.. A 'Ar A A .. A A A L I A A L I I A I A A r A iL:' A A r
11 1,.' AAA 'L A P A A A r r
A A 'r A A ; A
A A A A A r I A r A P A + I A I A A A
A. A A A A A A I A A I A r A A A I A , A
A � . "', "- A, , A '. P A, � I A A A 1. L A A A A A I
A I IP �r A. A L A r A, A
A , A A A L A A I I
At Ar L A A
W. I A A
A . + r. A A, P, A A I A A, A
A 10 - A A 1� I- . I A A I A
. ` L t
A A " P A A d A
A A r 1 .1 A A A A� A
L A A % A or + A L A A L A A r A A
+ r A I . 4 d A d A A A I A A A
A I A r A L A A A A A
A A A 7 A A I - A + A A
A A
A A tr A A W A'j A A A A 1 1. A A A
I r A I PAP r A 4 A A A
r r A A 4 A A I A A A
'A A A r A
L L A r r A A;
L A A A A.L A L A L r A
'.A r
A A A A A A
r A A L 4 P A A A A A A r A I A A A
A A A I A A
r A d A L L A A . : r I L
A A I A r A A A P L A A L
A I A L L A AL A A
A A A A A A I A A A A A A A A d A A A A A . A
L APA A PAPA A� A* A Lr P, p A A A . r L P A . . A . A . A L- , A . L A A A A A A L AP- A A L , A I A A A A A A L A A r A A I A. A . A L I A A A A A I
A A r A A A r A I
to L I A r A r r A A o A r A A A
A L A A A A A
A A
A A A A I L A A
A A A I A A A A A .
A I A A
L A A r LL P A I A A r A I A A
A A A A . I A I I A A A A A
A A A A A . i A A A A A A
A A A L L + A L A
r A L A A 4
A A A PL
L A. L A A A
A I A A A A
. A A
A , A r I r I - , Ar A A A kA L A A A I A A I A A A L A A A A
L L A A . ; � r A I
r. r A L A r A A A A L L r
L A A r A + A r A r
A A A A
r A r A
A r A A r L 4 A
to r A I A L + A L 6. 1 A ol� A A, i A I A A r A
r
+ r A A A A r A A A
r A A. I A L A A L L
I , r : I L I A : 1 A Pi
L A A A A A A A L " A A
A L A A
A P A A,A A' '6 A t A A� A A L L L L, A
A A
A A
+ L A A I A L L
A
I A r A
I I r . A L r L A A L A A A A
A L A A A :� I
A A A A A A A A A I
A L L A
A r A A A r A L A
A r L
A
A r
I A r r L,
L r A A r� A r
L A IAP A A A
d L A. ',A + + A A A L A A
A A I I i A L A i A
-A, A , r r A A
A A . A A A
A r A 4
A A A A r A A A r A
A I L ,
4 A L A
hLr.' ; r .� I I + A A
A ;r A A r A L A A A A
L r L. A A A d
L A A A A A 'r A r A r A L L A 11 A L L
A A L A A
r A A A r A A A A A
o r A A A A ' ' ' ' A L I A L r r A ' L
r A A .1 A A A
A A RECORD OF INSPECTIONS A A
'L. All P.
A,. L, No,.. Ir A "AAA. LA.
A A r A
A, r' A A A A A A rr L.P A L"4
% A A A r A r A r A r A A L A L A
A A A A r L L r 4 Date Passed I or A
IA I I A I A A A A I
A 1. o A L -1 Ar A A I r L All L, A A A
A A W A 4 A A A A 1, A L A r
A A L L d
A A A A L r A A A A A I A 1. A L A
A A I . A , r
A A A A _1 L
A r A A A A
r. A PA, A A A A .1 L L P. A L A A Foundation A A 1, 1 A A L r
r L A j A I 1 1 4 i
A A I I A I A A L L
qr. A , A I r. A A r A P A A A A A A I A A L L I
r A A I A r 1. A A A
+ L A A A I I A A Plumbing (PaiPtial), rr r
A 1, 1. A A A L.' r I A A L A A r I A P, L I
r I A + r A Pi". L A I . I
A A r A L I I .% A
A 1+j A A
A
A 1 .1 1. L , All L L P (Rough) A 'r r A A A r . 4 P .
I A A A A r A
A A A r A r A A
L 4 A jA . + A I A A r A I p A I L A r A S�� 6 -7 A 'S�� 0 A 1 A
L r 11"'rame k,� A 7 L A L A A A
A A A, L ;+ A P
IA, r rr I
A 1 A L. A A A L A A
A A L A I A A 1.
A A A A L A A rr
r Furnace & Fuel Lines. 11. 1. A
r .1� �A- A r L to A r A A A A L A A.o- A, I.r 11 A
A
A
A) A A A L I A t A r A �1. I I r A rL A 4 _M* r r A 'r 1. A,
r A A .1 A A Fina wv Lo L .4L,
A I I A A IL -&L4C- L :r � r
L � A A L A r L 4F
A I.A.- A 4 L P A A r I o, A.
_ A. Po� 'L f A A A A I A A
.4 A ; A , r A A PP A A
L A A A A , r A AA � . I . , L
A �4 r A A A A,
j A % ' L , L P I A A A P : A
A A A' "P` 'L A: A L A L A A
PP
APPAP
A
d L A A
A A A A + A A A A A
A L
A A L A A A A A A A A A L A A L
I., lor. A A r. A L A L L I
I A A A A A A r r
A A A A
L A + A A
I A A I L r A A A A A A A 'L k A LA
r A A r + A A A A A L r r A A A L
L j P z r
A r A A A
A A A A I A .1 L r P A A L A A L
A L A L L r A A r, A A A. A r r A A
A L L A r r L I A I I
A A 0 A I I I A I A L A A L A A r r r A I A A P. r A; I A
A A r I I , I A 11 A
A Lr A I A A L A A A A A
L r r A P-1 r A I L
r A A
,AA I A k. ...,o A A
A A I
r + H2 A A L A A A A A . A L A I A -r A A A A I A A r A r A A
A A r A
I A A A A t
A
, 6' APPLICATPLA & WORK OERMIT Application No. ... rz� .. Z.3
... .... ......
CITY OF EDMONDS Building Department Permit Limit, One Year
APPLICATION Is hereby made for a per t to construct the following work, in accordance with the accompanying plans
and specifications: ' I
171s� &4� I .............. No. Stories ............
. ................... Ground Area .....................
WORK — New/Addn. . .. ...................... . ...
AL 4
&//' 1�� .. . ... st. Type ...... ................................. Height ........................
-Plans Submitted . . /V - �
................... . ...... ..... i�
e ZoneA-�.&.X. Fire Zone .....................
LOCATION— Address ....... ...... ....................................... ........ . .......... rn . .................................. Us ...
-4-) --) L�2
Recorded Lot.01..eS ..... Block . ................... Add'n.7 a ........ ... . ..................... Sewerage..
.... . ....
Lot Arse . ....................................... Width. ........................... Min. Bldg. Setbacks, Front and Rear ................................ Sides ..............................
0 er ... ............... . . .. . ...... ........ ... Address ........................................................................ Phone ........................ .......
LI-7
Pi b ................... .. ... .. .
..... Address .... i ... 7-0.21-i . .... Phone.*
ddress ............ Phone 223
Bldg. . ....................................... ................ . ......................... ... z . . ........ C? K ...................
Plbg. by ........................................................................................... Address ........................................................................ Phone ................................
Heatingby ....................................................................................... Address ........................................................................ Phone ................................
Elect. by ........................................................................................... Address ........................................................................ Phone ................................
Remarks ...... NOTE ; ....P issued subject to conditions as noted on the attached sheet
@� . . . . . . . . . . . . . . . . . . . . 11161111� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The above to a correct statement and I agree to comply with all applicable Codes and State Laws regulating the work.
.............. ... ........................................... Date��..
Signed: Owner/Agent--,�-l-I...".*.",****",*,**I ........ .................... ddretij/
PERMIT for theab�ov ork is hereby approved, subject to the above conditions, and to compliance with the approved plans
r
and specifications and B Iding Department notations thereon.
VALUATION PERMT F!EES
$�N-IM.tq9 ............. Bldg . .... $17�!R9 .......................
APPROVED.
Date ......... 5
............................... .. I ...............
��n A ��K�WVP
Plbg.04� . s ... ......................
Heat.... $ .... .......................
Elect. . . . . $ ........................................
Others s .... 3.3.-.00 .......................
J:5UJLJU�411 Plan Check: -
By................................................................................... TOTAL FEE $15�-tQQ ......................
NOTES: No work requiring Building Department or City Engineer's Inspection shall be covered before inspection and approval.
Twenty-four (24) hour notice requested, Contact the City Engineer prior to construction of all site utilities, such as
curbs, paving, driveways, sewer, water and street connections.
goo,
7
1
p
p I
L i�."