740115.pdfFIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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YES [:I NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
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BUILDING DEPARTMENT Appnoau
ONE NUMBERtFIR
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PERMIT APPLICATION Imtdo Heavy Lines
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DEMOLITION
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REMARKS $WlIIIlI11Rg 001 �.K• t0 connect into
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I hereby acknowledge that I Gave rend this application; that the in-
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CITY
TELEPHONE NUMBER
Irrd agent of In. owner. 1 agree 10 Comply with City and state laws Mile-
ATTENTION
APPLICATION APPROVAL
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,Ming Construction; led In doing the Work authorised thereby, no person
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METER SIBS SERVICE SIZE CLEARANCE.
CHE D BY
Willbe employed In violation or tete Labor Code of the State of Washington
TIUS PER511T
This application is not a permit until
STATE LICENSE NUMBER
CITY LICENSE NUMBER
signed by the Building Official or his Dep -
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NOTE: Permit Limit One Year (Except DEMOLITIONS Which
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.hall be completed In ninety days; MOVED -IN BUILDINGS hall be nom•
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pitted In six ..0th..)
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INSPECTION
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Legal Description of Property (Show Below
or Attach FourCoCoopies)
REMARKS ���
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Any Construction oa the pubtlo denude (curb., sidewalks, driveways,
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REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
I
YES [:I NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
® RESIDENTIAL
GAS
GAS
❑ YES ❑ NO
,4
E] NEW
PLA CKED BY
THIS SITE IS LOCATED IN THE CITY
j -
El NON-RESIDENTIAL
❑ SI
OF EDMONDS. LOCAL SALES TAX
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ADD RETAINING
El WALL
ARKS
DEMOLISH
FENCE
Al U s-
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ALTER E]ORCFILLTE El s .......... Ft.)
REPAIR ❑ swim
IN P. ® POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Valuation Fso Receipt No.
S�JW1- 0,"/-
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Plan Check No .....................
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BUILDING
(((O
PROPOSED USE
PLUMBING
a PLOT PLAN (Indicate Building setbacks, abutting street.)
HEAT h GAS LINE
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FENCE
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SIGN
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RETAINING WALL
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N
SWIMMING POOL
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DEMOLITION
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PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I Gave rend this application; that the in-
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Iormnllon given 1s Correct; and that I am the owner, or the duly author-
Irrd agent of In. owner. 1 agree 10 Comply with City and state laws Mile-
ATTENTION
APPLICATION APPROVAL
.
,Ming Construction; led In doing the Work authorised thereby, no person
Willbe employed In violation or tete Labor Code of the State of Washington
TIUS PER511T
This application is not a permit until
retailing t0 workmen 'aCompensation Insurance.
AUTHORIZES
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, find receipt is ac -
IL
.hall be completed In ninety days; MOVED -IN BUILDINGS hall be nom•
knowledged in apace provided.
pitted In six ..0th..)
SIGNATURE (OWNER OR ADEN) DATE SIGNED
INSPECTION
I R'8 O ATU
-
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DEPARTMENT
CITY OF
EDMONDS
NOTE: AQplkant Subject to Plan Check Fee
PR 0•I101
Title Permit covin work to be done on private property ONLY.
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Any Construction oa the pubtlo denude (curb., sidewalks, driveways,
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marquee., will require separate pvmledon.
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USE
NE n PERMITNUMBER 1= )1 15
BUILDING DEPARTMENT AppucaDtFut /C S— ��
PERMIT APPLICATION +melds Heavy Llneg
NAMH (O NAMH OF HUBFNH88) ADDRESS
�UkN-��� PEIi 1188IBLE . 1rACTUAL
LOT COVERAOLf LOT COVHSYAOE
ILING
o /ACS t d aAHttH '._Gt. �J T h1o ,I
LL � I PERMISSIBLE HEIGHT PROPOSED JIFIGHT
CITY T P ONE NUMBER ACTUAL LOT AREA TOTAL. BLDG. AREA
El)rY7U/ t� D S 7 ��'��
REQUIRED YARDS PROPOSED YARDS {
NAME FRONT SID RF.. F/ FRONT SI E REAR �1
ADDRESS L£OAI. LOT VAItIA CE Oft CONpITIONAL USE; 3
d1.YE8i 0 NO / PERMIT NUMBER '1
U PL_ Ng D rT. P'OVAL . pp
ai CITY TELEPHONE NUMBER L- /(/` �/! / 7, —16 i
!c STREET/ /tV r,� / 1
EXISTING, STREET RfIP'? FT. DEFICIENCYTHHlIS PROPERTY
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A/7y,/AEy' rCOMP. PLAN ST. A LG'.
' cl / 1 L Pv oks / rREMARKS '
N ADDRE88 So)i.)rmi.n!* nool : O.K. to connect into
133��0 J 3 UTA ST` sanitary sew'2ry but with no larQgHIe1)Ex, lina than mail;
ld CI T Y T 1.EP,K ND NUp1D I �:V T,
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tJ METS$ S1LN, I SERVICE 81LE CLEARANCE CHkOKIiIDI BY 1
STATE LICENBM NUMBER I CITY LICENSE NUMBER `\-
a3— 0a - ( a o 6 REMARKS
Legal Deectlptlon of Property (Show Below or Attach Four Copies)
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TYPE CONNECTION
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Y PERC. TEST
W S For -7— 0!' ry s—y 6 TTi T J PERMIT UhIHF.A m
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.p7 REMARKS w
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FIRE ZONE I TYPF. OF roNwmw'«�r,nu
YES C] NO
El
IJ RESIDENTIAL
LINE
❑ YES [3 NO
PLAN
NEW
APPLICATION APPROVAL
Ixed agent of the owner. [agree to comDlr with City nisi .tato Iu- ATTENTION
lattng construction; sad 1n doing the work aUthorlud then r. n
will be employed In violation of the Labor Code of the state of Wn
relating to Workmen'. Compensation Ineuranq.
THIS PERMIT
CHECKER IIYq
THIS SITE IS LOCATED IN THE CITY
ADD
AUTHORIZES
ONLY TILE
NON-RESIDENTIAL
SIGN
WORK NOTED
OF EDMONDS. LOCAL SALES TAX
3L04.
❑
RETAINING
WALL
(OWNER R AQEN'11) DATE SIINSPECTIONONATUR}I/JtDEPARTMENT
RMMARKS :T
❑DEMOLISH
ALTER
EXCAVATE
FENCE
�'-s�i.i ✓l �(�Cr/ Gi✓ /
❑
OR FILL
❑ (......__[..........Fl.)
EDMONDS
REPAIR ❑
PRE -MOVE
SWIM
; l
/
I J<:'i L.
-Ilei
INSP.
® POOL
nutraueee, eta.) will reemre ep—t. pe d.almt.
NUMBER OF STORIES
NUMBER OF
'
DWELLING
UNITS
NATUflE OF WORK TO
HE DONE
`�J a/
Vniunllon
Fee Recel
Plan Check No .....................
Z
((y.�
BUILDING
ol PROPOSED VBE
PLUMBING
_
PLOT PLAN (Ind lea a Building setbacks, abutting streets
HEAT A GAS LINE.
1
FENCE
SIGN
--
RETAINING WALL
N
SWIMMING POOL
_
/Q
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby ack—ledge that I have read this application; thJ
In.
TOTAL AMOUNT DUE
formation given 1e correct; and that I am the owner, or the dur-
APPLICATION APPROVAL
Ixed agent of the owner. [agree to comDlr with City nisi .tato Iu- ATTENTION
lattng construction; sad 1n doing the work aUthorlud then r. n
will be employed In violation of the Labor Code of the state of Wn
relating to Workmen'. Compensation Ineuranq.
THIS PERMIT
This application is not a permit until
NOTE: Permit Limit One Year (Except DEMOLITIOch
AUTHORIZES
ONLY TILE
signed by the Building Official or his Dep -
ehall be completed In ninety days; MOVED
WORK NOTED
uty; and fees are paid, and receipt is ac-
-IN aoII.DINOe 'ha-
plct.d
pieted In six month..)NATURE
Scnowledged in apace provided.
(OWNER R AQEN'11) DATE SIINSPECTIONONATUR}I/JtDEPARTMENT
4
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CITY OF
EDMONDS
DATE V
'
NOTE: Applicant Subject to Plan Check Fee
PR a
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This Permit roves work to he done an private properly ONLY.
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Any construction oo the public denial. (carbo, sidewalks, d 10Us'
nutraueee, eta.) will reemre ep—t. pe d.almt.
INSPECTOR
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