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SIGN
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SWIMMING POOL
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BUILDING DEPARTMENT Applicant FiLL
NUMBER
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PRE -MOVE INSPECTION
PERMIT APPLICATION Inside heavy Lines
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ADDRESS
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EXCAVATION OR FILL
NAME (OR NAME OF BUSINESS)
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DPNPs
ACTUL
LOT COVERAGELOT COVJJAOE
read this application; that the 1n-
I hereby acknowledge that I have n
formation given le correct; and that I am the owner, or the duly author•
m
MCIN
Y
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APPLICATION APPROVAL
PERMISSIBLE HEIGHT PROPOSED HEIGHT
jyrg
30 Y a 18
r
ti
will beemployed I.vlolatlon of Me Labor Code of the State of Washington
THIS PER511T
a
CITYTE
PRON^E SR
ACTUAL LOT AREA TOTAL BLUO. AREA
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY Tilt
WORK NOTED
p y,
gO�l�
REQUIRED YARDS I-10poBED YARUH
knowledged in space provided.
leted In six meths.
NAME
FR T SID' REAR FR NT BIDE REAR
y
INSPECTION
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LN OAL LOT A )A (. Olt CONDITIONAL USE
DEPARTMENT
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;
ADDRESS
p YES 11 NO PERMIT NUMBER
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CITY OF
EDMOND
DATE
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PL O P Y OVA
PH 6-1107
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CITY
TELEPHONE NUMBER
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Any conetruetlea on the public domain (curbs, sId.vnaka, driveways,
;
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marqucesr ala.) wIB require separate pcemisslon.
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EXIB G STREET R/W ....... ..Fr. DEFICIENCY THIS PROPERTY
NAME
COMP. PLAN ST. R/W ............FT. ............FT.
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REMARKS
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ADDREIIS
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box alp
CHECKED HY
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CITY
ISELZPHONE NUMBER
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METER 812E
822E
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CITY LICENSE "I'M
IBEIV10E
ICLEARANCE
IClECKED
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Legal Description of Property (Show Below
or Attach Four Coples)
REMARKS
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OLD 1&14470L!/A/ 4Ss.a' t30791,04i sr,>
TYPE CONNECTION VERIFIED BY
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PERC. TEST PERMIT NUMBER
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
E)YES [3 NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
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RESIDENTIAL
❑ OAB
LINE
YES
❑ ❑ NO I
1
NEW
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
® NON-RESIDENTIAL
�t �1
IX I BION
«ie++
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31 04.
y
ADD RETAINING
El WAIT'
REMARKS
DEMOLISH
El ALTER EXCAVATE ❑ FENCE
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AI�SiV %7 IPI �/I(J//—GIP/• f .S«� l: dOG'r
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El REPAIR PRE -MOVE SWIM
INSP. EJ POOL
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NUMBER OF STORIES NUMBER OF
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DWELLING
UNITS
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NATO EE WORK TO BE DONE
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BUILDING
PROPOSED USE
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PLUMBING
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aPLOT
PLAN (Indicate Building setback., abutting street.)
HEAT 4 GAB LINE
FENCE
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SIGN
RETAINING WALL,.
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N
11
SWIMMING POOL
DEMOLITION
'
PRE -MOVE INSPECTION
I
EXCAVATION OR FILL
7 p
3Cji - 0 6
TOTAL AMOUNT DUE
read this application; that the 1n-
I hereby acknowledge that I have n
formation given le correct; and that I am the owner, or the duly author•
Ized agent of the owner. I agree to comply with city and elate laws rogu-
ATTENTION
APPLICATION APPROVAL
latlag construction; and in doing the work authorized thenby, no person
'
will beemployed I.vlolatlon of Me Labor Code of the State of Washington
THIS PER511T
This application is not a perinit until
relaung n Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY Tilt
WORK NOTED
uty; and fees are paid, and receipt is ac -
.hall be completed In ninety days; OVER -IN BUILDINGS .Mn be com-
knowledged in space provided.
leted In six meths.
DATE SIO ED
ED
INSPECTION
E O NATO E
' �
DEPARTMENT
;
'
CITY OF
EDMOND
DATE
--
NOTE: Applicant Subject to Plan Check Fee
PH 6-1107
This Permit coven work to be done on private property ONLY.
I
Any conetruetlea on the public domain (curbs, sId.vnaka, driveways,
j
marqucesr ala.) wIB require separate pcemisslon.
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ry
0
EXISTING STREET R/W ........ ...FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ...... :....FT. ............FT.
REMARKS
ADDRESS
box :I/S
CITY TELEPHONE NUMBER
Plnn Check N
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....................
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FIRE ZONE I TYPE OF CONSTRUCTIONSTREET-IMPROVED
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NOTE: Applicant Subject to Plan Check Fee
BUILDING
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PROPOSED USE
BUILDING DEPARTMENT
A,PU.tFW
ZONE ? I!)7
PLUMBING
PERMIT APPLICATION
Inelda Heavy Lines
ToneleTR
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DDRESS.
PLOT PLAN (Indicate Building setbacks, abutting street,)
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
NAME (OR NAME OF BUSINESS)
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-ACTUAL
❑
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LINE
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YE1iMltltlIDLE n
LOT COVERA ' LOT COVEWAOE
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MAILING ADDRESS
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PERMISSIBLE HEIGHT J1ROPOHHD HEIGHT
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SWIMMING POOL
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❑
ann
PRE -MOVE INSPECTION
CrIITYrr�
T P ON^E�NUMBER
ACTUAL LOT AREA TOTAi. U1.U0. AREA
EXCAVATION OR FILL
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lY A//%J/.'JI:'J7S LUhIS/Y
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TOTAL AMOUNT DUE
,
REQUIRED YARUH PROPOSED YARDS
ALTER
NAME
❑
FISONT SID}'. It F.AIt FRONT 11SIDE
REAR
ATTENTION
APPLICATION APPROVAL
❑
OR FILL
(........_z..........Ft.)
THIS PERMIT
This application is not a permit until
U
❑
LEGAL LOT VARIANCE Olt CONDITIONAL USE
❑
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N ADDRESS
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INSP.
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!UMBER OF STORIES
PL EP P YAsIA-E:
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DEPARTMENT
CITY I
TELEPHONE NUMDERl
ETRE— R/W
DWELLING
ry
0
EXISTING STREET R/W ........ ...FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ...... :....FT. ............FT.
REMARKS
ADDRESS
box :I/S
CITY TELEPHONE NUMBER
.:.' % C� , /J � ✓G_ ,C'% _ �t % i i � �JL J .� y /i'G �(ft. f"
Plnn Check N
t o-•' 1. r t v t
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....................
Z
FIRE ZONE I TYPE OF CONSTRUCTIONSTREET-IMPROVED
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NOTE: Applicant Subject to Plan Check Fee
BUILDING
',7 t�
PROPOSED USE
This Permit coven work to be done on private property ONLY,
PR g-1107
YES " NO
PLUMBING
Any construction on the public domain (enrbs, sidewalks, drlvewayn'
INSPECTOR
PLOT PLAN (Indicate Building setbacks, abutting street,)
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
O
❑ RESIDENTIAL
❑
GAB
LINE
C3 YES [] NO
ElNEW
BION
0
T
1
PLAN CHECKED DY 1 THIS SITE IS LOCATED IN THE CITY
N
NON-RESIDENTIALs1GN
SWIMMING POOL
j
�_ OF EDMONDS. LOCAL SALES TAX
❑
ann
PRE -MOVE INSPECTION
RETAINING
SHOULD OE CODED 31.04.
REMARKS
EXCAVATION OR FILL
DEMOLISH
L]WALL
TOTAL AMOUNT DUE
`.i
❑❑
ALTER
EXCAVATE
❑
FENCE
�:S/f /LL ,G/ (•�/'i; 'CS P.%/Y .� �J a oe:"
ATTENTION
APPLICATION APPROVAL
❑
OR FILL
(........_z..........Ft.)
THIS PERMIT
This application is not a permit until
REPAIR
❑
PRE -MOV E
❑
SWIM
) -y
' % : 'L� %l✓� �7/✓ ✓ L:.S,
shall be completed In ninety dnys;.)fOVED-1N IIUILDIN08 ,hail be cam-
knowledged in space provided.
INSP.
POOL
SIGNATURE (OW ER OR/AOPNT)1',' DATE BIONEDINSPECTION
!UMBER OF STORIES
NUMBER OF
l / �'. �.t C ) / 1. / % . /%(1' 1!,• l /
DEPARTMENT
DWELLING
UNITS
7ATURE OF WORK TO HE DONE
V.1 -tion Fe. Rccclpt
.:.' % C� , /J � ✓G_ ,C'% _ �t % i i � �JL J .� y /i'G �(ft. f"
Plnn Check N
t o-•' 1. r t v t
i
....................
Z
DATE _
-- ---
-
NOTE: Applicant Subject to Plan Check Fee
BUILDING
',7 t�
PROPOSED USE
This Permit coven work to be done on private property ONLY,
PR g-1107
PLUMBING
Any construction on the public domain (enrbs, sidewalks, drlvewayn'
INSPECTOR
PLOT PLAN (Indicate Building setbacks, abutting street,)
HEAT A GAS LINE
O
FENCE
BION
0
T
1
RETAINING WALL
N
I.
SWIMMING POOL
j
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
`.i
I hereby acknowledge that I have read this application; that the in.
formation given Is correct: and that I am the owner, or the duly author----./
)red agent of the owner. I agree to comply with city and state laws reg.-
ATTENTION
APPLICATION APPROVAL
latlpg cqustracttop; and In doing the work authorlmd thereby, no person
will be employed In violation of the Labor Code of the stats of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Ieeur .
AUTIIOT
RIZEBHE
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY
WORK NOTED
uty; and fees are paid, and receipt is ac -
shall be completed In ninety dnys;.)fOVED-1N IIUILDIN08 ,hail be cam-
knowledged in space provided.
,pleled In sla mouthy.) ) '�//'>
SIGNATURE (OW ER OR/AOPNT)1',' DATE BIONEDINSPECTION
D3 ECTOR'e SIGNATURE
l / �'. �.t C ) / 1. / % . /%(1' 1!,• l /
DEPARTMENT
f <_ y , ._ .;
CITY OF
t o-•' 1. r t v t
i
EDMONDS{---''-
DATE _
-- ---
-
NOTE: Applicant Subject to Plan Check Fee
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fff
This Permit coven work to be done on private property ONLY,
PR g-1107
i
Any construction on the public domain (enrbs, sidewalks, drlvewayn'
INSPECTOR
marquees, etc.) wW require separate permlealm.
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RECORD OF INSPECTIONS
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'Date- Passed ,.
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Foundation
Plumbing (Partial)
(Rough)
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Frame
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Furnace & Fuel Lines
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