740160.pdfSTATEWU ... MUMBER CITY CENSE NUMBER
1223 6 1 -532.1 I RE�HKa�!
Legal Description of Property (snow Below``or Attach Four °ogles)) 4r'+�N-I
TYPE CONNECTION VERIFI • D IIY
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REMARKS W
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J FIRE ZDAIL TYPE OfirCONBTRU ION 81'REET IMPROVED
/ I � �YE9
SPECIAL INSPECTOR REQUIRED OCCU ANCY ROUP
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OAS C1 YES j NO _
�EW RESIDENTIAL LINE PLAN CHECKED THIS SITE IS LOCATED IN THE CITY
u NON-REBIDENTIALBION% OF EDMONDS. LOCAL SALES TAX
ADD RETAINING RK SHOULD OE CODED 31.04, 1
DEMOLISH WALT //
ALTER ❑ EXCAVATE FENCE i0/1(r Q/(fs/'4(/GTIdN �L� (�(3 C% 177dOR FILL (......,..5..........Ft.)
El REPAIR ❑N8PPRE-MOVE
El POOL Sr�,r3<rec J %D Dom% S!7'"[_� /it/J/�LrCT/O!✓S i
NUMBER OF STORIES I NUMBER OF swim
DWELLING 1
UNITS
NATURE OF WORK
TO BE DONE Val -ti -Fee Receipt No.
/ 7 1
J2/ tf Lkj C' C Plan Check No .....................
[[O BUILDING aJ 7 •� �.!
3 ^m
ly PROPOSED USE pC Y'
a PLUMBING
—1:61S __0
PLOT PLAN (Indicate Building eetbaaka, abulltng atreete) HEAT A GAB LINE
5 I
FENCE
SIGN J
�. RETAINING WALL
SWIMMING POOL
I
n i2 — �•
DEDSOLITION �
PRE -MOVE INSPECTION
1 EXCAVATION OR FILL
x � i
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thl. application; that the 1n-
formation given 1. Correct; and that I am the owner, or the duly author- V
Iced agent of th.... r. I ..no to Comply with city and state law. ngu- ATTENTION APPLICATION APPROVAL -
,elle. construction; and In doing the work authorind thereby, no penou ,
will be employed 1. violation of the "her Code of the state of Washington THUS PERMIT This application is not a permit until
relating to Workmen'. Compen.ation Imureame. AUTHORIZER
ONLY THE signed by the Building Official or his Dep -
NOTE: Permit limit One Year (E.Cept DEMOLITIONS which WOICR NOTED uty; and fees are paid, and receipt is ac -
.hall be completed 1. bluely day.; MOVED -IN BUILDINGS shall be con- knowledged in space provided.
plated In et. months.)
SIGNATURE (OWNER OR GENT) DATE SIGNED INSPECTION 1 OR's ATU
3 _; 5-7 G/ DEPARTMENT l
CITY OF
EDhIOND9 DATE _
NOTE: Applicant Subject to Flan Check Fee
PR a-Ilo7
Thl. Permit coven week to be done on private property ONLY.
Any comtructhm oa the public domal. (curb., std—But, driveway., FILE
marquees, ate.) wW ngwn separate parm,aelm.
BUILDING DEPARTMENT
AppllcantFlu
ZOO �S^8 NVM"ER 740160
PERMIT APPLICATION
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ADDRESS
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NAME (OR NAME OF BUSINE88)
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PERMISSIBLE ACTUAL
IAT COVERAGE S 6 LOT COV ESiAOE
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PERNIBBIBLE IIEIOHT IEIG
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TELE HONE'
�NUMBER
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EXIBE6 STREETR/W/ ,... DEFICIENCY THIS PROPERTY
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NAME
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COMP. PLAN ST. R/lir'.' .. ,..FT.
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R11 Rks Drivewry slopes not ■t to exceed those
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07 ADDREBB /�
indicated on Standard Dwa No 103
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TEPLEPHONE NUMBER
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ME ER BILE H IC' IZ CLEARANCE t:ii• BY
STATEWU ... MUMBER CITY CENSE NUMBER
1223 6 1 -532.1 I RE�HKa�!
Legal Description of Property (snow Below``or Attach Four °ogles)) 4r'+�N-I
TYPE CONNECTION VERIFI • D IIY
s St i
�+ Pf TE
REMARKS W
a
a
J FIRE ZDAIL TYPE OfirCONBTRU ION 81'REET IMPROVED
/ I � �YE9
SPECIAL INSPECTOR REQUIRED OCCU ANCY ROUP
r' I I
OAS C1 YES j NO _
�EW RESIDENTIAL LINE PLAN CHECKED THIS SITE IS LOCATED IN THE CITY
u NON-REBIDENTIALBION% OF EDMONDS. LOCAL SALES TAX
ADD RETAINING RK SHOULD OE CODED 31.04, 1
DEMOLISH WALT //
ALTER ❑ EXCAVATE FENCE i0/1(r Q/(fs/'4(/GTIdN �L� (�(3 C% 177dOR FILL (......,..5..........Ft.)
El REPAIR ❑N8PPRE-MOVE
El POOL Sr�,r3<rec J %D Dom% S!7'"[_� /it/J/�LrCT/O!✓S i
NUMBER OF STORIES I NUMBER OF swim
DWELLING 1
UNITS
NATURE OF WORK
TO BE DONE Val -ti -Fee Receipt No.
/ 7 1
J2/ tf Lkj C' C Plan Check No .....................
[[O BUILDING aJ 7 •� �.!
3 ^m
ly PROPOSED USE pC Y'
a PLUMBING
—1:61S __0
PLOT PLAN (Indicate Building eetbaaka, abulltng atreete) HEAT A GAB LINE
5 I
FENCE
SIGN J
�. RETAINING WALL
SWIMMING POOL
I
n i2 — �•
DEDSOLITION �
PRE -MOVE INSPECTION
1 EXCAVATION OR FILL
x � i
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thl. application; that the 1n-
formation given 1. Correct; and that I am the owner, or the duly author- V
Iced agent of th.... r. I ..no to Comply with city and state law. ngu- ATTENTION APPLICATION APPROVAL -
,elle. construction; and In doing the work authorind thereby, no penou ,
will be employed 1. violation of the "her Code of the state of Washington THUS PERMIT This application is not a permit until
relating to Workmen'. Compen.ation Imureame. AUTHORIZER
ONLY THE signed by the Building Official or his Dep -
NOTE: Permit limit One Year (E.Cept DEMOLITIONS which WOICR NOTED uty; and fees are paid, and receipt is ac -
.hall be completed 1. bluely day.; MOVED -IN BUILDINGS shall be con- knowledged in space provided.
plated In et. months.)
SIGNATURE (OWNER OR GENT) DATE SIGNED INSPECTION 1 OR's ATU
3 _; 5-7 G/ DEPARTMENT l
CITY OF
EDhIOND9 DATE _
NOTE: Applicant Subject to Flan Check Fee
PR a-Ilo7
Thl. Permit coven week to be done on private property ONLY.
Any comtructhm oa the public domal. (curb., std—But, driveway., FILE
marquees, ate.) wW ngwn separate parm,aelm.
NO
Plan Check No .....................
BUILDING
PROPOSEDUSE
PLUMBING
J
NEW
AD.
RESIDENTIAL
❑ NON-RESIDENTIAL
DEMOLISH
o
Ej
GAS
I.,,
RETAINING
WALL
0 YES 'D NO
PLA ' N CHEC!FD BY THIS SITE IS LOCATED IN I Ht CITY
(;..(r.I. OF EDMONDS. LOCAL SALES TAX
i -SHOULD BE CODED 31.04.
REMARKS,
ALTER
] REPAIR
❑ EXCAVATE
OR FILL
PRE -MOVE
I❑ NSP.
USX PERMIT
FENCE
( I I . .......... Ft.)
swim
POOL
BUILDING DEPARTMENT
cant M
Applicant M'
ZONE NUM13M
APPLICATION
Heavy Lines
Inside Heavy Lines
.IOD
B
/
PERMIT
DEMOLITION
NAMB,(OR N E Oil I�USIVIESB)
ACTUAL
PFRMIBSIBLE 4�' -Ij
COVERAGE - LOT COVE AGE j�
LOT W
V11111111 Foe R 111 No,
M•AI•LING AD
TOTAL AMOUNT DUE
PERMISSIBLE HEIGHT
0
Eft
TOTAl,
5PTST
r
Islip. .-Amation; and In doing the work authorized thereby, no person
will be employed In vj.kstkm of the Labor Code of the State Of Washington
z
ne,wul—D YARDS YA RUB
REAR
AUTHORIZES
NOTE: Permit Limit One Your (E.c.pt DEMOLITIONS Which
ONLY THE
WORE NOTED
shall be completed 1n -laity day.: MOVED -1N BUILDINGS shalt be corn-
1.1PROPOSED
- FUPNT
110N
pl,l,d 11 ILIF—Ithe"
NAME
-7-
INSPECTION
USE
DEPARTMENT
ADDRESS
L
7:';y_—VARlANCE OR CONDITIONAL
�,T NUMBER
NOTE: Applicant Subject to Plan Check Fee
,8
PR 0.1107
71f d",
/W
:T.W. aDEFICIENCY PROPERTY
I
STREET THIS
NAM ' E
COMP. PLAN ST. R/W ............ FT. ..!2 Fr.
-KO—DRESS
REMARKS urivL752 F,151—
indicated on Standard n,19. NO. 103.
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61
51
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C;Ty
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V
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A
C'T Y LICENSE NUMBER
-7r SIZE SER V SIZE CLEARANCE
[CHECJj1EU "I
STl� LICENSE NUMBER
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Legal Deso ription OfProperty(nQW Be[on
OrItIalbPon, C
L T,,'y_
A
TYPE CONNECTION
IT—RCTEST P1111T UMBER
y
REM
11 �i 1\71
11 M
I I I N
U)
NO
z
Plan Check No .....................
BUILDING
PROPOSEDUSE
PLUMBING
_PLOT
NEW
AD.
RESIDENTIAL
❑ NON-RESIDENTIAL
DEMOLISH
o
Ej
GAS
I.,,
RETAINING
WALL
0 YES 'D NO
PLA ' N CHEC!FD BY THIS SITE IS LOCATED IN I Ht CITY
(;..(r.I. OF EDMONDS. LOCAL SALES TAX
i -SHOULD BE CODED 31.04.
REMARKS,
ALTER
] REPAIR
❑ EXCAVATE
OR FILL
PRE -MOVE
I❑ NSP.
El
FENCE
( I I . .......... Ft.)
swim
POOL
j
RETAINING WALL
4UMBERUMBER or
SWIMMING POOL
/
ZWELL NO
I
DEMOLITION
I NITS
NATURE OF WORK TO BE D014E
EXCAVATION OR FILL
V11111111 Foe R 111 No,
z
Plan Check No .....................
BUILDING
PROPOSEDUSE
PLUMBING
_PLOT
PLAN (Indicate BUIlding setbacks, abutting street.)
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation give. 1e correct; and that I son the Owner, or the duty acithos•
ited a"" Of the Owner. f acres to comply with city and state lam raim-
a
ATTENTION
Islip. .-Amation; and In doing the work authorized thereby, no person
will be employed In vj.kstkm of the Labor Code of the State Of Washington
TINS PERMIT
relating to Workmen'. Camp .... it.. Initurence.
AUTHORIZES
NOTE: Permit Limit One Your (E.c.pt DEMOLITIONS Which
ONLY THE
WORE NOTED
shall be completed 1n -laity day.: MOVED -1N BUILDINGS shalt be corn-
pl,l,d 11 ILIF—Ithe"
ga'A' DATE PIONED
S107
NW;rUE. ER GEN�)/
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0.1107
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged In space provided.
IDJ�WCTOR'B i 81 . ONATURE.
I
DATE
d
This p.—It covers work to be done On privet. P -M -7""'I
Any remitruction an the P-1,116 domain (--be, -id---Jk-- Art away., INSPECTOR
marquees, to.) will remire iiel'"Ste permission.
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