740126.pdfBUILDING DEPARTMENT
USE
PERMIT
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AppLcant F11I
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NUMBER 40 12b
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PERMIT APPLICATION
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NAME (OR NAME OF BtMNESa)
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PERMtee18L
LOT COVERAGE
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InA1L1NG ADDRESS
"DRESS
LOT COVEIkAOE
0 e-PERMISSIBLE
RETORT
PIiOPOSED HEIGHT
CITY ♦♦w�
ds
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ACTUAL LOT AREA
TOTAL HLDO. AREA
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REQUIRED
NAME
YARDS
PRON77
PROPOSED YARD.
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REAR FRONT BIDE REAR
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LEGAL LOT
13 YEB NO
VARIANCE OR CONDITIONAL USE
PERMIT NUMBER
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CITY
TELEPHONE NUMBER
PLANNING DEPT. APPROVAL [ I DATE:
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STREET R/W
NAME
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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COMP. PLAN /W IT.
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ADDRESS '
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TELEPHONE NUMBER
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CHECKED BY
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V STATE LICENSE NUMBER
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CITY CENSE NUMBER
METER SIZE ( SEIiV1C➢ SIZE CLEARANCE
CFIECKED BY
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Legal Deeeriptlon of Property (Show Below or Attach Four Copl..)
REMARKS
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TYPE CONNECTION
VERIFIED BY
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PERC. TEST
PERMIT NUMBER
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REMARKS
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P e,—t l Qh TA o4(/
FIRE TYPE OF CONSTRUCT1I0N STREET IMPROVED
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Q [I YES NO
9PE AL INSPECTOR RE tRED OCCUPANCY
NEW RESIDENTIAL ❑ LINE
GROUP
❑ YEB NO
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PLAN CHECK
THIS SITE IS LOCATED
NON-
®® RESIDENTIAL
SIGN
IN THE CITY
OF EDMONDS. LOCAL SALES TAX
ADD
RETAINING
DEMOLISH � WALL
REMARHS
ALTER EXCAVATE FENCE
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OR FILL
6.........x..........Ft.)
REPAIR PRE-MOVE
SSM
❑ INaP. POOL
NUMBER OF STORIES INUMBER 08
DWELLING
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UNITS
NATURE OF WORK TO BE DONE
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Valuation
Ire. Reeelpt No.
1
Plan Check N
11
° �arTs
PROPOSED US
BBUILDING5-00
0� 00
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PLUMBING---
Cl PLOT PLAN (Indl.ate Hulitling eetbecke, abutting et[Cete)
-
0
HEAT a, GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE-MOVE INSPECTION
EXCAVATION OR FILL
I Rer.by acknowledge o,,.et; that I have read this apDllcalion; that We Is.
formntlan given la correct; and Ulat I am the owner, or the dulr author-
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eC I '77Oq
TOTAL AMOUNT DUE
Ired agent of the owner. I agree to comply with city
and at ab Iaws Pogo.
Iating wmtructloa; and In doing the work authorized thaaby, no person
will
ATTENTION
APPLICATION APPROVAL
em0tayed In violation of Me Labor Coda of the State of Washington
in
relating to Workmen-, Compensation I"Unta".
THIS PERMIT
AUTHORIZES
This application Is not a permit until
NOTE: Permit Limit One Year
ONLY TITS
signed by the Building Official or his Dep_
s •—' ��
(Egnpt DEMOLITIONS which
.hall be compieled in alnely day,; MOVED-IN BUILDINGS shall be Som-
WORK NOTED
uty; and fees are paid, and receipt is ac.
Pitted 1. e1. month..)
1cnoWledged in Space pk'ovlded.
SIGNATURE OWNER OR AGENT)
DATE 81 NNED
INSPECTION
3_Z� 7y
DEPARTMENT
DIRECTOR'S BtGNATU £�
CITY OF
NOTE: Applicant Subject to Plan ChcFee
EDMONDSck
DATE
�7
PH 6-1107
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Tide Permit .oven work to be done on private pro
Any rnnelrp.tloo on the P.1,11. domala ( -111, std.-JIx..,, A,l aYj�,
mora ore., rtr.l will reeulrr e[perate Dvndeelon.
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-7LI0126
RECORD OF INSPECTIONS
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Date Passed
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Foundation
Plumbing (Partial) —
(Rough)
Frame
Furnace 9, Fuel Lines 4`— 1
"Final
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-7LI0126
RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial) —
(Rough)
Frame
Furnace 9, Fuel Lines 4`— 1
"Final
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