740091.pdfI
ING DEPARTMENT
Legal Description of Properly how Below OrnAttach Four Copies)
j T / y1 5
Applicant Fill
USE E NUMMBBER 740091
VERIFIED BY
IT APPLICATION
Inside Heavy Linea
ao `
ADDRESS ' % O O 3 —
/ 7 %� I
PLOT PLAN (Indicate Building setbacks, abutting streets)
QF aUBIN$@e)
n
^'o
�
b ��/
ACTUAL
I �) tfI 1 R K
I\r/ rv/
IAT COVERAGE
LOTC VERA
LOT COVERAGE
.7
SS ^}_y.
tRETAINING
PERDfItl816LE HEIOIIT
PI30PO8ED HEIGHT
N
L
9P AL INSPECTORREQUIRED
�'� �
FADDRESS
T� ��
ACTUAL LOT AREA
TOTAI. eLDO. AREA
[3YES -%No
C/•
REQUIRED YARD8
PROPOSED YARDS
ADD ❑
DEMOLISH
ALTER CE
RETAINING
E] ALL
❑ PENCE
HIDE REAR
FRONT SIDE REAR
1FRONT
OLEGAL
❑ OR FILL( ......... x .......... Ft.)
lied agent at the owner. I agree to comply with city and state law. regu-
REPAIR [:3PAMOVE
INSP.
POO
OL
P&^A
LOT VARIANCE ORCONDITIONAL USE
3 YE8[] NO PERMIT NUMBER
NUMBER OF STORIES NUMBER OF
THIS PERMIT
PLANNINGDEPT. APPROVAL ,
Iy�
t V w ,' DATE:
�I
AUTHORIZES
DWELLING
TELEPHONE NUMBER
STREET R/W
utyi and fees are paid, and receipt Is ac -
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
Ol ADDRESS
9 — ICHECKED BY
F CITY PHONE NUMBER WI
0 TELEI METER SIZE I SERVICE SIZE I CLEARANCE I CHECKED BY
ey.��
0 C•GI-�F"�i'T �6 G�B,,.LPe 1J
4 PROPOSED USE
Legal Description of Properly how Below OrnAttach Four Copies)
j T / y1 5
TYPE CONNECTION
VERIFIED BY
'��IL)rTQ 't�'�)jA)
VON �t� I`
O
PLOT PLAN (Indicate Building setbacks, abutting streets)
L.l�I�"
n
PERC. TEST
PERMIT NUMBER
N I`M•>t�'�$'
W
4
REMARKS
FIRE ZONE TYPE OF CO STRU 'ON STREET IaiPROVI
.7
tRETAINING
l I
YES NO
N
9P AL INSPECTORREQUIRED
OCCUPANCY GROUP
1
'Q' I
NEW l
NON-RESIDENTIAL
CAH-
1011RESIDENTIAL LINE
[ sHR,
[3YES -%No
'.!(. I
PLAN CHECKED x
j
THIS SITE IS LOCATED THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 3104
ADD ❑
DEMOLISH
ALTER CE
RETAINING
E] ALL
❑ PENCE
REMARKS
ALL Wu
r— y��nM V
formation given Is correct; and that I ade the owner, or the duly author -
❑ OR FILL( ......... x .......... Ft.)
lied agent at the owner. I agree to comply with city and state law. regu-
REPAIR [:3PAMOVE
INSP.
POO
OL
P&^A
NUMBER OF STORIES NUMBER OF
THIS PERMIT
This application is not a permit until
relating to Workmen'. Compensation Insurance.
AUTHORIZES
DWELLING
NOTE: Permit Limit One Year (Eicept DEMOLITIONS which
ONLY III E
WORK NOTED
utyi and fees are paid, and receipt Is ac -
.ball be completed In ninety day4; MOVED -IN BUILDINGS shall be nom•
UNITS
knowledged In space provided.
plcicd cis month )
NATURE OF WORK TO BE DONE
INSPECTION
DIRE ' B ATURE
�y'
Valuation
Fee Rece
ey.��
0 C•GI-�F"�i'T �6 G�B,,.LPe 1J
4 PROPOSED USE
Plan Check N. .....................
BUILDING
py,
PLUMBING
O
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT d: GAS LINE
9
N I`M•>t�'�$'
FENCE
BION
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
SOO 1 b1
I hereby acknowledge that I have read 161e aDDllcatian; that the in.
formation given Is correct; and that I ade the owner, or the duly author -
lied agent at the owner. I agree to comply with city and state law. regu-
ATTENTION
APPLICATION APPROVAL
laths construction; and In doing the work autborlred thereby, no Peron
will be employed In violation of the labor Code of the elate Of wmhington
THIS PERMIT
This application is not a permit until
relating to Workmen'. Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Eicept DEMOLITIONS which
ONLY III E
WORK NOTED
utyi and fees are paid, and receipt Is ac -
.ball be completed In ninety day4; MOVED -IN BUILDINGS shall be nom•
knowledged In space provided.
plcicd cis month )
SIGWA' HE (0% R A r NT) DATE SIGNED
INSPECTION
DIRE ' B ATURE
�y'
DEPARTMENT
CITY OF
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
eR a -IIsi
—
TNe Permit coven work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalk., driveway.,
marquee., etc.) will require separate permission.
FILE
R
G
,`)1 tJr,e_ Ct —
Beiow or A[lacn F0
T vo 3
►A G 1.1,
LEGAL LOT VARIANCE OR CONDITIONAL USE
0 YES NO PERMIT NUMBER
PLANNING DEPT. APPROVAL }� CJ �' (�.,- DATE:
STREET RIW I` p
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
. C
z
w
CHECKED BY
PLUMBING
N
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
FIRE ZONE: TYPE IIFF I
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
SPECIAL INSPECTOR REC
�•
$red agent of the owner. 1 agree to eomD1Y with city and slate lawn regu-
ATTENTION
URE /�' PERMIT
11
El RESIDENTIAL
NEW
• NON.nESIDENTIAL
ADD ❑ DEMOLISH
ALTER EXCAVATE
❑OR FILL
REPAIRo IRE -MOVE
GAS
LINE
❑ SIGN
❑ yAETLAR•nN6
FENCE
(......... .x .......... Fl.)
O SWI
POOL
PLAN CHECK D EKY
1� _
BUILDING DEPARTMENT
Applicant Ful
ZOO R�' NuntRER
This application is not a permit until
relating to Workmen's Compensation Insurance.
I I DWELLING
PERMIT APPLICATION
I Imide Heavy Lines
ADDRESS �)
17 � � ...w
� �.-
uty; and fees are paid, and receipt is ac -
iATURE OF WORK TO BE DONE
NNNAAAIyy{{{E (OR NAMLLEJ77 F $U-B1N��44B) 'v y� •�
j \j
•'�
knowledged in space provided.
plated $n'six mouths:)
1 ..
.^,L,
LOT COVERAGE
LOT
I:
�
BUILDING
INSPECTION
,J � f X31)
LOT CSS1SLE
LOT COVERAOFe
��,,.-!2 �� l�• /
DEPARTMENT
r
MAII.Tt�O ADDRESS /•�
_ ��
V
10
PERMISSIBLE HEIGHT
O
PROPOSED HEIGHT Z
I'
DATE
C
/' j/ / /
Ota �l
E HONES -/j UYfB`F,'•/R/y
�M
�"`^"
ACTUAL LOT AREA
TOTAL BLDG. AREA1
I:
This Permit coven work to be done as private property ONLY.
I
VI%V(��� \.
/ I
REQUIRED YARDS
PROPOSED YARDS
marquees, ete.) will reeWre separate DUWsslon.
FRONT SIDE REAR
FRONT SIDE REAR
(NAME
-
G
,`)1 tJr,e_ Ct —
Beiow or A[lacn F0
T vo 3
►A G 1.1,
LEGAL LOT VARIANCE OR CONDITIONAL USE
0 YES NO PERMIT NUMBER
PLANNING DEPT. APPROVAL }� CJ �' (�.,- DATE:
STREET RIW I` p
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
. C
z
w
CHECKED BY
PLUMBING
N
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
FIRE ZONE: TYPE IIFF I
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
SPECIAL INSPECTOR REC
$red agent of the owner. 1 agree to eomD1Y with city and slate lawn regu-
ATTENTION
[3 YES ff NO
El RESIDENTIAL
NEW
• NON.nESIDENTIAL
ADD ❑ DEMOLISH
ALTER EXCAVATE
❑OR FILL
REPAIRo IRE -MOVE
GAS
LINE
❑ SIGN
❑ yAETLAR•nN6
FENCE
(......... .x .......... Fl.)
O SWI
POOL
PLAN CHECK D EKY
1� _
REMARKS l
AL-�
will be employed In violation of the Labor Code of the State of Washington
(UMBER OF STORIES NUMBER OF
This application is not a permit until
relating to Workmen's Compensation Insurance.
I I DWELLING
signed by the Building Official or his Dep -
,
NOTE: Permit Limit One Year (Except DEMOLITIONS which
UNITS
uty; and fees are paid, and receipt is ac -
iATURE OF WORK TO BE DONE
knowledged in space provided.
plated $n'six mouths:)
Pion Cheek Nn .....................
-V-�Y I� �� �`• •'-i ,C.� h rL,t _.,
BUILDING
� � i 1AtJCQ
-
PLUMBING
N
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
f)It
STRUCTION . STREET la1PROVF
0 I ❑ YES NO
'.ED I OCCUPANCY GROUP
THIS SITE 15 LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 3104.
Valunllon Fee Receipt No.
AMOUNT DUE
�+) t " b7
'
ls application; that the fn-
I hereby acknowledge that I have rend this
'
formation given Is correct; and that I an. the owner, or the duly author.
$red agent of the owner. 1 agree to eomD1Y with city and slate lawn regu-
ATTENTION
APPLICATION APPROVAL
lat$ng conatruetlon; and In doing the work authorised 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 Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TIRE
WORK NOTED
uty; and fees are paid, and receipt is ac -
shall be completed In Woety day/; MOVED -IN BUILDINGS shall be cone-
knowledged in space provided.
plated $n'six mouths:)
SIGNATURE WPNE AOENT) DATE SIGNE'DJ.
INSPECTION
DIRECTOR• Si ai TIJI{A__--•�'
��,,.-!2 �� l�• /
DEPARTMENT
r
L IGC- /� /'t._-_.., /l�GLe /T
CITY OF
' ,����
L ..
DATE
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1.107
_ -
This Permit coven work to be done as private property ONLY.
I
Any eouslrucllon an the public domain (curbs, sidewalks, driveways,
INSPECTOR
marquees, ete.) will reeWre separate DUWsslon.