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PERMIT ,t 0�OG^
S 4
NUM Eft
BUILDING DEPARTMENT Applicant FW
ZONE
PERMIT APPLICATION Inside Heavy Lines
I
NAME (OR NAME OF BUSINESS)
%
PERMISSIBLE ^
Lor covERAG>;'°
DTCTUAL JII//��
LOT COVERAGE
"1
m
MAILING ADDRE00
31ElAIiT
PItOPOtlEU 11EIOHT O
f
/T
��
TOTAL BLDG. AREA
I
CITY TE N 88:R
ACTUAL LOT AREA
AECTU U LUT
a�
REQUIRED YAItDe
PROPOtlEUYARUS
i
FRONT SIDE
REAR FitONT SLUE REAR
•1
,
NAME
LEGAL LOT VAR(.\NCE OIt CUNIIITIONAL USE
ADDRESS
0 YEB I] NO PF;RhIIT NUMBER
7
PLANNING DEPT. APPROVAL DATE:
CITY TE PHONE NUMBER
STREET R/W
EXISTING STREET Ft/W ............FT,
DEFICIENCY THIS PROPERTY
1
NAME
COMP. PLAN ST. R/W
FT. ............FT.
RDMAAKS
CITJ'{�6ill NUMBER
8
��.., I7 Z V LZ L] t7
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
ea(`
STATE LICENS NUM ER C3T CENSE U waEK
I
I I
aa3 - of-i�g h
REMARKS
<
Lego( Descrlptlon of Property (Show Below oe Attach Four CODIes)
TYPE CONNECTION
VERIFIED 6Y
•,
I
PERC. TESTI
PERTIIT NUMBER
I
G
1
WREMARKS
W
m
j
<
W
—
FIRE ZONE OF CONSTRUCTION BTAEET IMPROVED
(TYPE
YES ❑ NO
SPECIAL INSPECTOR REQUIRED
GROUP
OAS
REBID£NTIAL LINE
NEW
❑ YO11 NO
(OCCUPANCY
II
!
—8
PLAN CHECKED HY
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
NON-RESIDENTIAL eISB
ADD ❑ RETAINING
DEMOLISH WALL
❑
SHOULD BE CODED 3104.
'
REMARKS
❑ ALTER ❑ EXCAVATE FENCE
OR FILL � (......... s .......... Ft.)
,
REPAIR ❑ NBP. MOVE ❑ swim
POOL
NUMBER OF STORIES NUMBER OF
I
DWELLING
UNITS(
NA R(E�OFf./W�UAK BE DONE �I
Vnlantlon
Fee RccelPl No.
:
�t/U!F/LL'iL/(/f
Plan Check No .....................
t
BUILDING
(O
4 PROPOSED UBE
�q
PLUMHIN6
W PLOT PLAN (Indicate Building setbacks, abutling atrcete)
HEAT &CAB LINF,
:i
o
FENCE
SIGN
{
tRETAINING
WALL
N
—
ISWIMMING
POOL
DEMOLITION
I
I
PRE -MOVE INSPECTION
EXCAVATION OR FILL
1
TOTAL AMOUNT DUE
I hereby acknowledge that I have rend thle applicatlon; that the In-
formation Elven In correct; and that I am the owner, or the duly authar-
Ized agent of the owner. I agree to comply with city and .tate IaWS regu-
ATTENTION
APPLICATION APPROVAL
1. ng constiactlon; and re doing the work authorized thereby, no par...
will be employed In violation of the Labor Code of the State of Washington
TIUS PERMIT
This application is not a permit until
relating to rkmen4 Compensau.0 Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NO P 'mit Limit One Year (E -.Pt DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac
s 1 be co plated In ninety days; MOVED -IN BUILDINGS Shall be Som-
knowledged in Space provided.
.
.ted In It liath1.)
INSPECTION
DEPARTMENT
DIRE R'8 8 6NATU ,�:..
�,
SIGN (OWNER OR AGENT)/ DA' S GNED
✓
CITY OF
,/YZ�;(�.�.✓,i
EDffiOND3
DAT ,
—
N E: Ap 'ant Subjret to Plan Chrek Fre
PR d-3107
This Permit coven work to he done on private property ONLY.
Any eoestenctlon on the public domain (carpe, Sidewalks, drlvewye,
FILE
mareuaee, etc.) .111 1.4011. Sew". pandA.Ion.
ANE NUM IETR .7 ^ n-Jn7
\� BUILDING DEPARTMENT ApplloantFBI qqq r.
PERMIT APPLICATION inside Heavy Lines
NAMESAR NAME OF BUSINESS) PF.ItMIeeIBLF, m ACTUAL
--y-"Jj" AOEe LOT COV
F.S�AOE
YES 0 NO
N
m
IMPROVED 7Y
YES ❑ NO
ROUP
TED IN THE CITY -I
)CAL SALES TAX
1 31.04.
/VJ!//L L. L.IeJ/U ✓ii(=J,✓!V J(/�ivv,-��
E SIGNED
G"• I J' ��f�
IAT COVER
O
El NEW
PEKMieSIDLE HEIGHT PROPOSED HEIGHT
PLUMBING''
BLDG. AREA
NON-RESIDENTIAL
O
SIGN
ON .R
ACTUAL LOT AREA TOTAL
CITJ'i
FENCE
YAUd
1'ItOPOB YARDS
DEMOLISH
❑
WALL
ALTER
FRONT' BIDE RAR FRONT BIDE REAR
EXCAVATE
ORFILL
E]
NAME
REPAIR
❑
�+
a
LEGAL LOT ARIANCE Olt CONDITIONAL USE
VUMBER OF STORIES
al
ADDRESS
OYES ❑ NO PERMIT NUMBER
'
F�
PLANNING DEPT. APPROVAL DATE:-
DWELLING
I
EXCAVATION OR FILL
P ONE NUMBER
j
CITY
STREET
EXIeTING STREET R/W ............FT. DEFICIENCY TIile PROPERTY
NAME
COMP. PLAN ST. R/W ............FT. ............FT.
,
tlo}�
(//� //
Y'7 Cyf-s L �1 G//e./C lA , //VC—
REMARKS
c,
zW
N
ADDREtlB
/Y.(l `, J._ c.
CHECHED BY
lied agent of the owner. I agree
let,.. pon.trnctton; and m doing the work authorized the.by, no person
will be employed In violation of the Labor Code of the Stats of Washington
Cl YLEPHONE
NUMBER
S-
CLEARANCE
CHECKED BY
AUTHORIZES
ONLY THE
Signed by the Building Official or his Dep -
uty; and fees are paid, and receipt is Be
NOTE: P rmit Limit One Year (Except DEMOLITION& which
METER 812E SERVICE 812E
.bill be co Plated In niaetY daY.; MOVED -IN BUILDINGS shall be am-
ST� ENBr
CITY CENSE NUMHEK
I I
I
I,N,,
D OR'B NATU
%UMBER' j �;
I
I
REMARK.
�y
YES 0 NO
N
m
IMPROVED 7Y
YES ❑ NO
ROUP
TED IN THE CITY -I
)CAL SALES TAX
1 31.04.
/VJ!//L L. L.IeJ/U ✓ii(=J,✓!V J(/�ivv,-��
E SIGNED
E]RESIDENTIAL'n
GAS
LINE
El NEW
ly PROPOSED USE
PLUMBING''
❑
NON-RESIDENTIAL
[:]
SIGN
ADD
IQING
FENCE
❑
DEMOLISH
❑
WALL
ALTER
❑
EXCAVATE
ORFILL
E]
FENCE
.......... Ft.)
REPAIR
❑
INSPIdOVE
a
SPOOL
VUMBER OF STORIES
NUMBER OF
PRE -MOVE INSPECTION
DWELLING
I
EXCAVATION OR FILL
j
UNITS
YES 0 NO
N
m
IMPROVED 7Y
YES ❑ NO
ROUP
TED IN THE CITY -I
)CAL SALES TAX
1 31.04.
/VJ!//L L. L.IeJ/U ✓ii(=J,✓!V J(/�ivv,-��
E SIGNED
Plan Check No .....................
\ `•J 01J
BUILDING
ly PROPOSED USE
PLUMBING''
OPLOT PLAN (Indicate Building setback., abutting street.)
HEAT & GAS LINE
lKl
FENCE
SIGN
RETAINING WALL
N
-
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
j
TOTAL AMOUNT DUE
7777
1 hereby ackpowladee that I have rend this appllcatlon; that the In-
formation given is correct; and that I am the owner, or the duty author -
to comply with City and state laws mgu-
APPLICATION APPROVAL
lied agent of the owner. I agree
let,.. pon.trnctton; and m doing the work authorized the.by, no person
will be employed In violation of the Labor Code of the Stats of Washington
ATTENTION
THIS PERMIT
This application is not a permit until
.,at,. tom rkmen'■ Compen.ntim Ituurana.
AUTHORIZES
ONLY THE
Signed by the Building Official or his Dep -
uty; and fees are paid, and receipt is Be
NOTE: P rmit Limit One Year (Except DEMOLITION& which
WORK NOTED
.bill be co Plated In niaetY daY.; MOVED -IN BUILDINGS shall be am-
knoWledged In space provided.
i5leted In z .the.)
ION INSPECT
D OR'B NATU
e1GNAT n (OWNER OR AOENT)J DA J
Jl� 7 DEPARTMENT
CITY OF
J hEDDSONDS DATE
/ F
NOTE: AQQ 'ant Subject to Plan Ceck Fee T
PR a-IIOY V
T61. Pemrlt cave. work to be done on "'.16 property ONLY, +
Any construction on the public domain (emb., .Idewallu, drlvewaY., INSPECTOR
marquee., etc,) Will reemre separate permission.