740221.pdf1
BUILDING DEPARTMENT
USE PERMIT 22I
ZONE � �-/z NUMBER
Applicant Flit
PERMIT APPLICATION
I Inside Heavy Lines
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ADDRESS
NAME (OR NAME OF BUSINESS)
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PERMISSIBLE i A AL
LOT COVERAGE �Jir�D/b L COY AGE
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PROP�/Pe:RM1tltlIBLE HEIO}T
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ACT A L TARE TOTAL IIL A A
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REQUIRED YARDS PROPOSEDYARDS
NAME
FRONT BIDE REAR FRONT SIDE REAR
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ADDRESS
LEO LOT VARIANCE OR CONDITIONAL 9E
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e NO PERMIT' NUafB
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CITY
TELEPHONE NUMBER
PLANNING DEP VAL
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STREET R/W
EXISTING STREET R/W`^.7. D 1CIENCY THIS PROPERTY
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NAME
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COMP. PLAN ST. R/ 1.
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REMDriveway slopes not to exceed those
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ADDRESS
indicated on Standard Dwg. No. 103
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CHEC E BY
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CITY
TELEPHONE NUMBER
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STATE LICENSE NUMBER
I CITY LICENSE NUMBER
METER SIZE
SERVICE SIZE CLEARANCE
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CHE ED IIY
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Legal DeecllptlOn of Property (Shaw Below of Attach FOYr Coplee)
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REMARKS
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FIRE ZONE TYPE OFCONSTRUCTION BTREE IMPROVED
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SPECIAL INSPECCT�ORRp REQUIRED
OCCUPANCY GROUP
RESIDENTIAL A
B"„,EW El LSINE
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PLAN CHE E BY
THIS SITE I LOCATED IN THE CITY
NON-RESIDENTIAL ❑ SIGN
❑ ADDSHOLII
Of EDMONDS. LOCAL SALES TAX
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RETAINING
DEMOLISH WALL
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75
ElALTER ❑EXCAVATE O FENCE
OR FILL
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REPAIR E]INePMOVE I ' u POOL
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NUMBER OF STORIES NUMBER OF
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DWELLING
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TI UNITS Q A)( -
au h
NATO,, OF WORK TO HE DONEII
Valuation
Fce Receipt No.
AjC L, C��f . t7.J 0 14entle-
Plan Check No ................ _...
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PR OBE UBE � , �
HUILDIN6
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PLUMBING
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PLOT PLAN (Indicate Hulldlog eetbacke, abutting etreete)
HEAT & GAS LINE
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FENCE
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WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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I hereby RCkOOWledge that I have read thte application; that the In.
forma"on given la correct; and that I am the owner, or the duly author.
Ized agent of the Owner. I agree to Comply With city and elate ..We ..a.
lefing con.teuctlOn; and in doing the Work authofind thereby, no person
ATTENTION
APPLICATION APPROVAL
will be employed In Wolattoa of the Labor Coda oI the State of Waahlagton
THIS PERMIT
This application is not a permit until
relaune to Workmen'. Compenaauon Inauraaoe.
AUTHORIZES
signed by the Building Official Or his Dep --"—
NOTE: Permit Limit One Year (Except DEMOLITIONS which
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ONLY THE
ut and fees aro paid, Bred [CCCi t i9 6C-
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shall be completed In NRaty days; MOVED -IN MOULDINGS atoll be mm-
WORK NOTED
Imowledged In space provided.
plete In elz menthe.)
N URE (OWNER OR ENT)DATE
SIGNED
INSPECTION
1 T R' SIGN TU
DEPARTMENT
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CITY OF
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EDHONDS
DATE I
NOTE: Applicant Subject Pian Check Fet
7
TNe Permit coven work to be Gone on private property ONLY.
PA 6•3107
Any run.l ..rife. -- the pnhllc demaln (curb., sidewalk., driveway.,
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nMt partlon of Gov=mMnt Lot 8803" 1*, TdWadU 27 ... �
Mutlow ksAp'1 3ait,
1tffi., %Ob mieb Oount,7o MR01a$6ma dsaaribed as-faliovat -at a -c_
one West line, of Count' load vhl" is -Aorto 1052'vest 830 foot a d anth 88 31
Wo5st 30rest from the Scuthaaet CUSW of said oovcrmmt Lott thus aoutb
99033' West 460 feet] then idol 32000° gest 129'festl Uwe" Ult 4U.B4 feet
to a point on Heat line of Counly Aaadj ubsch is loo teat Sorth of point of
beAi=insl tbance South &long hest line of said Doul! Road to point of begimLing.
ESOT"! the East 320 feat of North 65 feet] situte is the ammly of Mala,
State of Ashingtonl Subject toe Patera later ri®hte and all natters pertaining
tbar4tos Easement recorded X y 22, 1964 under Aymditor'e Vn:e go."1491
for ingress aFA, *asp end fah Gouty p.A.D.', sad vest.0oast
'is3eph�. C+o. linea, recorded ildYr iaiditor�'e lila go.i269�699i Sasetnsat recorded
June 12, 1967 under d�itora e. Ails lfe,el9bt6�1 flea eca iMom Bald oovnante
Containedla Apeemaat`to KsintaLt �ar� 40t`'.S�orded "s