740062.pdf1I FIRE ZONE TYPE
SPECIAL INSPECTOR
GAS❑
L.LHDENTIAL LINE PLANCHECKED❑OIIYNEW N -RESIDENTIAL ❑ BION
ADD 1:1 DEMOLISH [:]WALL KING REMARKS
ALTER ❑ OR FILL AVATE ❑ FEN Cz.......... Ft.)
0 YES (] NO
CY GROUP
LOCATED IN THE CITY
i. LOCAL SALES TAX
REPAIR ❑ PRE-MOVEElswim
INSP POOL
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UNITS
BUILDING DEPARTMENT Applicant Fal
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NATURE OF WORK TO BE DONE
PERMIT APPLICATION Inside Heavy Lines
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Compliance Inspection
Plan Check No .....................
ADDRESS
17109 - 67th West
NAME (OR NAME OF BUSINESS)
PERMISSIB E % ACTUAL
BUILDING
Karol A. Los
LOT COVERAGLOT COVERAGE
PROPOSED USE
MAILING ADDRESSG
PEItMIdtlIDLE HEIGHT PROPOSED NEIOHT
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17109 - 67th West
OPLOT PLAN (Indicate Building setback., shutting streak)
HEAT @ GAS LINE
CITY T PHONE NUMBER
ACTUAL IAT AREA TOTAL BLDG. AREA
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Edmonds, WashingtonREQUIRED
YARU9 PROPOSED YARDS
FENCE
NAME
FRONT SIDE REAR FRONT BIDE REAR
p
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WALL
LEGAL LOT VARIANCE OR CONDITIONAL USE
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ADDRESS
[3 YES NO YERAtIT NUMBER
SWIMMING POOL
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PLANNING DEPT. APPROVAL DATE:
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CITY TELEPHONE NUMBER
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STREET R/\V
EXISTING STREET R/W ............FT. DEFICIENCY TING PROPERTY
O
EXCAVATION OR FILL
NAME
COMP. PLAN BT. R/W ............P2'. ............FT.
Compliance Inspection
25.00
RDMARIIH
TOTAL AMOUNT DUE
2C� 00
ADDRESS
I hereby acknowledge that I have read this application; that the In-
formatlan given I. correct; and that I am the owner, or the duly author-
CHECKED DY
Ized agent of the owner. I agree to comply with city and state laws regu.
CITY TELEPHONE NUMBER
APPLICATION APPROVAL
lating construction; and in doing the work authorized thereby, ao parson
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METER NILE SERVICE SIZE CLEARANCE CHECKED BY
THIS PERMIT
This application is not a permit until
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relating to Workmen'. Compensation Insurance.
STATE LICENSE NUMBER CITY LICENSE NUMBER m
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Signed by the Building Official or his Dep -
NOTE: Permit limit One Year (Except DEMOLITIONS which
F
Uty; and fees are paid, and receipt Is ac -
.hall be completed In ninety day.; MOVED -IN BUILDINGS shall be co o.
REMARKS
g
pleled In ala months.)
Legal Description of Properly (Show Below .1 Attach Four Copies)
SIONATU1tE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
131R OR'S ONATU
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Lot 3 Double DD Ranch Tracts
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Commercial Mortgage Corp. 2-15-74
CITY OF
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TYPE CONNECTION VERIFIED BY
EDMONDS
DATik.�'j
NOTE: Applicant Subject to Plan Check Fee
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1 PF.R11fIT NIITtBER
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This Permlt coven work to be done on private property ONLY.
1I FIRE ZONE TYPE
SPECIAL INSPECTOR
GAS❑
L.LHDENTIAL LINE PLANCHECKED❑OIIYNEW N -RESIDENTIAL ❑ BION
ADD 1:1 DEMOLISH [:]WALL KING REMARKS
ALTER ❑ OR FILL AVATE ❑ FEN Cz.......... Ft.)
0 YES (] NO
CY GROUP
LOCATED IN THE CITY
i. LOCAL SALES TAX
REPAIR ❑ PRE-MOVEElswim
INSP POOL
NUMBER OF STORIES NUMBER OF
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DWELL NO
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UNITS
NATURE OF WORK TO BE DONE
Valuation
Fee Receipt No.
Compliance Inspection
Plan Check No .....................
O
BUILDING
PROPOSED USE
PLUMBING
-
O
OPLOT PLAN (Indicate Building setback., shutting streak)
HEAT @ GAS LINE
FENCE
SIGN
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
1
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Compliance Inspection
25.00
TOTAL AMOUNT DUE
2C� 00
I hereby acknowledge that I have read this application; that the In-
formatlan given I. 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.
ATTENTION
APPLICATION APPROVAL
lating construction; and in doing the work authorized thereby, ao parson
will be employed 1. violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
+
relating to Workmen'. Compensation Insurance.
AUTHOFUZEB
Signed by the Building Official or his Dep -
NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
Uty; and fees are paid, and receipt Is ac -
.hall be completed In ninety day.; MOVED -IN BUILDINGS shall be co o.
knowledged in space provided.
pleled In ala months.)
SIONATU1tE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
131R OR'S ONATU
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Commercial Mortgage Corp. 2-15-74
CITY OF
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EDMONDS
DATik.�'j
NOTE: Applicant Subject to Plan Check Fee
PH 0-1107
This Permlt coven work to be done on private property ONLY.
Any construction on the public domain (garbs, sidewalks, drIlmaira.
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mnrauees, etc.) will rtenir. saparst. per d.doo.
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PERMIT
BUILDING DEPARTMENT
Applicant Fill
°NE NUMBER
PERMIT APPLICATION
Imide heavy Linea
ID
ADDRESS
I I 109 — 6I'th Wrist
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NAME (Ott NAME OF BUSINESS)
Karol A. Lo,.
PERMISSIBLE ACTUALJJ
LOT COVERAOE LOT COVERAGE
AILING ADD B87
PERMISSIBLE HEIGHT PROPOSED HEIGHT
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CITY
PRONE NUMek:ft
ACTUAL LOT AREA TOTAL BLDG. AREA
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Ld7nond5, vlashington
REQUIRED YARD8 PROPOSED YARDS
SIDk: REAR
NAME
FRONT S)DE REAR FRONT
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LEGAL LOT VARIANCE OR CONDITIONAL USE
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ADDRESS
(3 YES NO P'ItIHT NUMBER
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PLANNING DEPT. APPROVAL DATE:
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CITY TELEPHONE
NUMBER
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STREET RIW
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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NAME'ye/�Li'!7I
COMP. PLAN BT. R/W ............FT. .... .. . FT,
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REMARKS
ADDRESS
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CHECKED BY
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CITY TELEPHONE
NUMBER
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METER SIZE
SERVICE SIZE
CLEARANCE
CHECKED BY
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STATE LICENSE NUMBER
LICENSE
CNUMDER
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REMARKS
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Legal Description of Property (Show Below or Attach Four Copies)
Lot 3 Double DD Ranch Tracts
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TYPE CONNECTION VERIFIED BY
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PERC. TEST
PERMIT NUMBER
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FIRE ZONE TYPE OF CONSTRUCTION
STREET IMPROVED
YES 0 NO
SPECIAL INSPECTOR REQUUIRED-11
OCCUPANCY GROUP
RESIDENTIAL
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❑ LINE
0 YES 0 NO
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NEW
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
❑ NON-RESIDENTIAL
etox
OF EDMONDS. LOCAL SALES TAX
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ADD
RETAINING
REMARKS SHOULD BE CODED 31.04.
ElDEMOLISH F1 WAIT'
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DALTER EXCAVATE FENCE
OR FILL (.....................Ft.)
REPAIR ❑ PRE -swim
NSP. O POOL
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NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
V¢luntlon
Fec
Receipt No.
Comp! iancli Inspection
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Plan Check No. ...................
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BUILDING
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PROPOSED USE
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PLUMBING
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aPLOT
PLAN (Indlente Building eeln¢Ckeany, gtFept()�
HEAT h GAS LINE
FENCE
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SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
COmy l 1 8n(:f. i n'ipi
Ct l C;n
%� • 7(1
TOTAL AMOUNT DUE
25,00
fj"/
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.
lied agent of the owner. I agree to comply with city and state laws ragu-
ATTENTION
APPLICATION APPROVAL
Iating 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
This application is not a permit until
relating to Workmen's Compensation fosuraace.
AUTHORIZES
Signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
uty; and fees are paid, and receipt is ac -
shall be completed In Mindy days; MOVED -IN BUILDINGS shall be win.
knowledged in space provided.
pieted In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DI OR'S 8 NATU
:,;rty,nt' Corp. :'--I 7%,
DEPARTMEN T
'l. Cj
('cr^warctal
'
CITY OF
_ . -----
NOTE: Applicant Subject to Plan Cberk Fee
EDMONDS
PR 0-1101
DAT
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This Permit coven work to be done on private property ONLY.
Any construction on the public domain (eurbs, sidewalks, drlvewa)s,
INSPECTOR
marquees, Ste.) will require Separate permission.
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RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
(Rough) —
Frame
:;Furnace
& Fuel Lines --:,—
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