740101.pdf_-.._._ --.7
BUILDING DEPARTMENT Applicant Fill ONE NU H3MR 740101
PERMIT APPLICATION Inside xeRYy LiDeB A 6:53 � 3 G�C• /�
ADDRE88
E (OR NAME OF BUBINE88)
/ _ _ . .. n a . PERMISSIBLE ACTUAL
LOT COVERAGE LOT COVIrWAOE
YES 0 NO
Sy"
LEGAL LOT VARIANCE OI[ CRONDITIONAL USE
T MBE
O YES 0 NO PERMINU
aUjADDRESS
M
RESIDENTIAL
W
PLANNING DEPT, APPROVAL DATE:
NUMBER
OE CITY
❑
T LEPHONE
STREET R/\V
O
.W7
FIRE ZONA I TYPE OFC UC
NON-RESIDENTIAL
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN BT. R/W ............FT. ............FT.
NAME
BE CODED 31.04.
may)
d W Q C 1 l+
REMARKS j
REMARKS
-
ADDRESS
(00.7
❑
SWI
(�L /—(�
�GI `-
1 Jy REPAIR ❑ NSP. ❑ POOL
I CHECKED BY
dCz'y),t_(' r(� �L.yN ?()
CITY
TELEPHOND NUMBER
UNITS
I
NATURE OF WORK TO BE DONNE�
Valuation
7
METER SIZE
I SERVICE SIZE I CLEARANCE
CHECKED BY
STATE LICENSE NUMBER
CITYLIOEROWNUMBER
I.ecnl Drecrletlnn at
Pro.erty IS— Below
I
or Attach Four Come.)
REMARKS /'
.. 1 / .. •
YES 0 NO
Sy"
PERO. TEST
n
RESIDENTIAL
W
REMARKS
THIS SITE IS LOCATED IN THE CITY
❑
❑
O
.W7
FIRE ZONA I TYPE OFC UC
YES 0 NO
11
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I (
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I
I
❑ GAS
❑ YEB MY
❑ NEW
RESIDENTIAL
LINE
PLAN CHECKS DY
THIS SITE IS LOCATED IN THE CITY
❑
❑
OF EDMONDS, LOCAL SALES TAX
NON-RESIDENTIAL
SIGN
BE CODED 31.04.
❑ ADD RETAINING
❑ DEMOLISH ❑ WALL
REMARKS j
�%�'7CH'Ol1LD
L' 1 /�
ELD I3a.-+"I QD
OACFII,AI.TE ❑ FENCEc..........Ft.)
❑j ALTER
1 NJTA'��- •t JIz A I SNI
❑
SWI
(�L /—(�
�GI `-
1 Jy REPAIR ❑ NSP. ❑ POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONNE�
Valuation
Fee Receipt No ,
e1
D�
1:51I a'`D
�" r^
Pion Check No.
BUILDING
PROPOSED USE
`yl
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting street.)
HEAT A GAR LINE
07
FENCE
SIGN
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUES
.'y
that
I hereby acknowledge that I have read this application; that t1in.
/
formation given Is correct; and that I athe owner, or the
am, author-
ized agent of the owner. 1 agree to Comply with city and state laws Mqu-
ATTENTION
APPLICATION APPROVAL
lating Conetruetlon; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Slate of Washington
THIS PERMIT
This application is not a permit until
releting to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (ESC.pt DEMOLITIONS which
ONLY TIIE
WORE NOTED
utyi and fees are paid, and receipt is ac -
.bail be completed In ninety days; MOVED -IN BUILDiNGR shall be ram-
knowledged in space provided.
pleted In hl months.)
BAT,
S1GNA E (OWNER O AGENT) DAT 816 ED
INSPECTION
DIRECT '8 8 NA WIE
r.
DEPARTMENT
CITY OF
EDIMONDS
DATE
NOTE: AQj7lrcdfft Su jrct to Plan he Fee,9
PR a-3107
This Permit Coven work to be done oh Driva property ONLY.
Any eon truellnn on the public domain (curbs, Sidewalks, drivaways,
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RECORD OF INSPECTIONS
' Date Passed
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Foundation
i Plumbing (Partial.) -----
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