740140.pdfFi
BEAR
ILDING DEPARTMENT AppllPmtFillZONE
NUMBPERMER 7�14U
PERMIT APPLICI►TION In�me iieaYy LiReB JOB
ADDRESS /%off �, ��--�,)I� G�c
ME (OR NAME OF BUSINESS) ACTUAL j a
r PERMISBIBLE % LOT COVdAOE
1i� L% 1- N 5 �J 1/a 1 H ( f LAT COVERAGEILING ADDRE00 PROPOSED HEIGHT
PERT3188IBLE HE16R
W ADDRESS
Y ITE
CITY
NAME
I- �+
C AD I[£SS
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t9 CITY
F
fc -7 o>`l �
STATE LICE SE NUDiBER ICI
7 _moi —0 7.., / /1 -/
— -%I—
, / 4
PLANNING DEPT. APPROVAL A // DATE:
�/
STREET R/[Y t
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN eT. R/W ............F!. ............ FT.
AEMAItICB
SPECIAL INSPECTOR REQUIRED
CISECKED BY
N�
RESIDENTIAL
HER�jyB�ZE CLEARANCE
ME/'/�
CF3ECKE9 Bir
/ZE I
I
I
REMARKS/lV^Mn�._—/_
i
TYPE CONNECTION I VERIFIED BY
PBRC. TEST PERMIT NUMBER
REMARK.
/l
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
RESIDENTIAL
GA8
❑ YES ❑ NO
DY
IN THE CITY
011E101
LINE
PLAN CHECKED
THIS SITE IS LOCATED
EDMONDS. LOCAL SALES TAX
2/NON-RESIDENTIAL
❑ BION
cHOULD BE CODED 3104
RETAIADD E]DEMOI.I-11 O WALL, KING
REMARKS
EXCAVATE FENCE
stf /%/✓�' (jDi+// .�L✓L /� / T / �'"
ALTER
OR FILL (.....................Ft.)
REPAIR ❑ PRE-INSP. ❑ POOL
�tJ%SL/G (,t%�f.0-"/GT Sr"<<: /—/�/�Tie/✓S
NUMBER OF STORIES I NUM➢ER
DWELLING/I%1/f''S/1�1L�
UNITS
NAT�URE OF WORK TO BE DONE
Valuntlon
Fee
Rccc. No.
!-
f 6 L( X-1 / /'-f r — /1/// / A/ k=,- G d /2 1�
rl¢n Check No .....................
/L'%1/l Uf/ f7L �"/t!//
BUILDING
4 PROPOSED OBE
PLUMBING
k GAB LINE
PLOT PLAN (Indicate Building eetb¢cks, abutting sheet.)
'-f
HEAT
�/�/:/i/�.G•y
FENCE
`i`�/L'�C.-/ .�L= �.�.L
/ iD ✓J /�N
SIGN
/Z lJ�O el
RETAINING WALL
SWIMMING POOL
GC/ ✓ ` G ' ( %
�L! /
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
C / ,7
H.(
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given Ie correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with ally and state laws regu-
ATTENTION
APPLICATION APPROVAL
lating 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
.,at,.. to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
ut and fees are paid, and receipt iB ac -
y'
.hall be completed In ninety days; MOVED -IN BUILDINGS shall be coon.
knOWlsLged:space provided.
pleted In six months.)B16NATURE
INSPECTION
D EC ODEPARTMENT
(OWNER OR AGENT)
DATE SIGNED
u
CITY OF
'�
EDMONDS
D/
NOTE: Applicant Subject to Plan Check Fee
PR 6-1101
This Permit coven work to be dans on ..Irate property ONLY.
Any construction on the pub8e domain (curbs, sidewalks, driveways,
FILE
marquees, etc.) will require separate permission.
r
BUILDING DEPARTMENT Appiicaat Fill ZONE {� j (•^ NUMBER
PERMIT APPLICATION I Inside Heavy Lines Loa
ADDRESS
AE
NAME 1011 NMOF BUSINESS) •� / '' /' f (�
-t- _ PF;ItAI ltla18LE
.0 1 )= , 1 4= C 1-) i- 1-i�IC? i ( 1 C I ! 1 I F LOT COVERAGE- LO'
T
0
U
N ADDREtlB �
CITY TELEPHONE NUMI1111
V STATE LICEIqSE NUMBER CITY LICENSE NUMI
—o2--1 /11--/ -3
FRONT HIDE HEAR FRONT HIDE REAR
% I
LEGAL LOTS USE
YE9 NO PF,RANT NUAtBEILNDI7'IONAL
GAS
LINE
PLANNING DEPT. APPROVAL /r� /
DATE:
STREET R/W
NEW
EXISTING STREET R/W ............Fr. DEFICIENCY
THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............
FT•
REMARKS
NOTE: Permit Limit One Year (Except DEMOLwhich
2/..IDENTIAL
BY
1:
OF EDMONDS. LOCAL SALES TAX
AGE
ADD
METER SIZE SERVICE SIZE
CLEARANCE
[EIGHT
0
PR 0.1107
❑ ❑ WALL
1. AREA
Any coa.tructioo on the public domsla (curbs, sidewalks, driveways,
I
I
G'%/'-�+/ 7 ',J
DPOHF.D YARDS
` L' • '
ALTER ❑
OR FILL � (..........z..........Ft.)
FRONT HIDE HEAR FRONT HIDE REAR
% I
LEGAL LOTS USE
YE9 NO PF,RANT NUAtBEILNDI7'IONAL
GAS
LINE
PLANNING DEPT. APPROVAL /r� /
DATE:
STREET R/W
NEW
EXISTING STREET R/W ............Fr. DEFICIENCY
THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............
FT•
REMARKS
NOTE: Permit Limit One Year (Except DEMOLwhich
2/..IDENTIAL
BY
/ (CHECKED
OF EDMONDS. LOCAL SALES TAX
ADD
METER SIZE SERVICE SIZE
CLEARANCE
CHECKED BY
SHOULD BE CODED 31.04. _
PR 0.1107
❑ ❑ WALL
REMARKS
Any coa.tructioo on the public domsla (curbs, sidewalks, driveways,
/ f/( Fri.' LvI��/:✓ e;( � j' It/ y.. /..i F �_"%✓
G'%/'-�+/ 7 ',J
[] YES [] NO
-7/7771
APPLICATION APPROVAL
This application is not a permit until i
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged to space provided.
)
DIRECTOR'S SIGNATURE
' I
DATE
INSPECTOR
RESIDENTIAL
GAS
LINE
YES NO
❑PLAN
i
NEW
ATTENTION
be employed In violation of the Labor Code of the State ington
CHECKED❑BY
THIS SITE IS LOCATED IN THE CITY
NOTE: Permit Limit One Year (Except DEMOLwhich
2/..IDENTIAL
slax
OF EDMONDS. LOCAL SALES TAX
ADD
INSPECTION
DEPARTMENT
CITY OF
RETAINING
REMARKS
SHOULD BE CODED 31.04. _
PR 0.1107
❑ ❑ WALL
Any coa.tructioo on the public domsla (curbs, sidewalks, driveways,
EXCAVATEPENCE
=='� '�''
` L' • '
ALTER ❑
OR FILL � (..........z..........Ft.)
❑PRE -MOVE SWIM
REPAIR ❑ INEP. POOL
_ / :� L :' •y.i.- / v. f
.S ,/ / i - .� G /�;'-"-',".S
NUMBER OF STORIES NUMBER OF
DWELUNITSLINO
I
I
NATURE OF WORK TO BE DONE
Valuation Fe. Receipt No.
Pion Check No_ ..................
C)-/ .= 1:.�/�Ji/-
BUILDING
Yy PROPOSED USE `O\
PLUMHIN6
96 oa
tabutting
PLOT PLAN (Indicate Building setbacks, streets)
HEAT A GAS LINE
A-1
'J _
FENCE
SIGN
RETAINING WALL
_ ., �.-_---•'--"•
SWIMMING POOL
1
.. �. -�l �i.• �/ / ._"
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
-7/7771
APPLICATION APPROVAL
This application is not a permit until i
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged to space provided.
)
DIRECTOR'S SIGNATURE
' I
DATE
INSPECTOR
TOTAL AMOUNT DUE
the In-
I hereby acknowledge that I have read this apPlicatlojper.on
tormatlon given to correct; and that I am the owner, or thuthor.
[zed agent of the owner. I agree to Comply with city and elregu-
latlag construction; and in doing the work suth.ri..d therpersonwill
ATTENTION
be employed In violation of the Labor Code of the State ington
THIS PERMIT
relating toWorkmen'- Compensation Insurance.AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLwhich
ONLY THE
WORK NOTED
.hall be completed In nicety days; MOVED -IN BUILDINGSe com-
pleted In sixSIGNATURE
(OWNERORAGENDATED
1
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0.1107
This Permit cover- work to be done on private properly ONLY.
Any coa.tructioo on the public domsla (curbs, sidewalks, driveways,
marquees, etc.' will require separate Permlulon.
-7/7771
APPLICATION APPROVAL
This application is not a permit until i
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged to space provided.
)
DIRECTOR'S SIGNATURE
' I
DATE
INSPECTOR
�:
l'
4
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