740244.pdfI PERMIT
E BUILDING DEPARTMENT pppllenntFlu USE
NDI'B�I 740244
PERMIT APPLICATION I Inside Heavy Lines JOB
ADDRESS �i /
N MH (OR NAME OF BUBINE �G AAL
I) 9"— n 10
LOT CO ERA LOT COVEItAOE
Y LOT COVERAOEc
It.r,
kUj
'JyPLANNING
yr
NAMSI
pDDREeB
I hereby acknowledge that I have read this apPllention; that the In-
FRONT SIDE REAR FRONT Bwc
LEGAL0 LOTPVARIANCE OR ERMIT NUMBER CONDITIONAL USE
YES 0 NO
DEPT. APPROVAL DATE:
y0
CITY
TELEPHONE NUMBER
ATTENTION
luting construction: and In doing the work authorized thereby, an person
NAME ) ,t
will be employed In violatloa or the Labor Code of the Slate of Washington
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN BT. R/W ............FT. ............FT.
relating to Workman's Compensation Insurance.
AUTHORIZES
-�/�1�T�`J-��JIW(f /lg
ONLY TIIE
µ•ORE NOTED
REMARKS
Q
88
IIONA U E (ON V ER OR AGENT)
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OOL
CHECKED BY
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Cpl Y
TELP ONE NUMBER
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F
C
EDMONDS
METER SIZE SERVICE SIZE CLEARANCE CHECKED HY
O
STATE LICEN/B�0 NUMBE
CITY LICENSE NUMBER
I I I
Any construction on the public domain (eurb., sidewalks, driveways,
REMARKS
Attach Hour Copies)
RESIDENTIAL LINE
NEW ❑ NON-RESIDENTIAL ❑ SIGN
ADD EJDEMOLISH O WALL RETAINING
ALTER ❑ OR FILLS ❑ (ENC............Ft.)
swill
REPAIR ❑ INSP, O POOL
DUMBER OF STORIES I NUMBER OF
DWELLING
UNITS
FIRE ZONE I TYPE OF CONSTRUUrli
SPECIAL INSPECTOR REQUIRED IC
❑
YE 8 F NO
PLAN CHECKEDHY THIS
OF I
YES 0 NO
LOCAL
N
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Valuation Fee Receipt No.
FrENCE
........_...........
�a
B LINE
— 40 WALL Pool-
DEMOLITION
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this apPllention; that the In-
formation given Is correct; and that I am the owner, or the duly authur-
tzed agent of the owner. I agree to comply with city and at"* laws regu-
ATTENTION
luting construction: and In doing the work authorized thereby, an person
will be employed In violatloa or the Labor Code of the Slate of Washington
THIS PERMIT
relating to Workman's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TIIE
µ•ORE NOTED
shall be completed In ninety day.; 31OVED-IN BUILDINGS shalt be com-
pleted In .Ix menthe.)
IIONA U E (ON V ER OR AGENT)
DATE 16N D
INSPECTION
OOL
/ 3
DEPARTMENT
N
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Valuation Fee Receipt No.
FrENCE
........_...........
�a
B LINE
— 40 WALL Pool-
DEMOLITION
J
Ise—
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 spaceprovided.
D ,TOR'S NAT I
DAT
FILE
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this apPllention; that the In-
formation given Is correct; and that I am the owner, or the duly authur-
tzed agent of the owner. I agree to comply with city and at"* laws regu-
ATTENTION
luting construction: and In doing the work authorized thereby, an person
will be employed In violatloa or the Labor Code of the Slate of Washington
THIS PERMIT
relating to Workman's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TIIE
µ•ORE NOTED
shall be completed In ninety day.; 31OVED-IN BUILDINGS shalt be com-
pleted In .Ix menthe.)
IIONA U E (ON V ER OR AGENT)
DATE 16N D
INSPECTION
/ 3
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fre
775-2525
Thla Prrmit c, cork to be dans n private property ONLY.
Any construction on the public domain (eurb., sidewalks, driveways,
marau See, etc.) will repWre separate prrml..lon.
J
Ise—
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 spaceprovided.
D ,TOR'S NAT I
DAT
FILE
YES C] NO
'
SPECIAL INSPECTOR REQUIRED
I OCCUPANCY GROUP
I
BUILDING DEPARTMENT AppllcantFnl
USE PERMIT
ONE NUMBER
GAS
❑ RESIDENTIAL ❑ LINE
❑ YES S, ❑ NO
`�--
PERMIT APPLICATION Inside Heavy Lines
I
JOB / �a•f / /
ADDRESS �'.�
❑ NEW
Nl(MII
(OR NAME OF EUs1NEe )
I N
pERM[89IBLE I ACTUAL J
NON-RESIDENTIAL ❑ SIGN
EDMONDS.
SHOULD BE CODEDLO3104
`l CC 4�`•
LOT COVERAGE LOT COVERAGE
❑ ADD
RWALL KING
REMARKS
MAILING ADD 89 �///'�—'A /
PERMISSIBLE HEIGHT PROPOSED HEIGHT
t7
;
E ❑ FENC........... Ft.)
❑ ALTER ❑ EXAVATORFILL
—
AREA TOTAL BLDG. AREA
IG
❑ REPAIR ❑ IN PbIOVE ❑ SWI I
POOL
TELEPHONE NUMBER
CITY
ACTUAL LOT
.
'
DWELLING
I
REQUIRED YARDS PROPOSED YARDS
UNITS
FRONT SIDE REAR FRONT_ BIDE REAR
NATURE OF WO K TC BE DONE "; i
Valuation
Fco Receipt Nov
- t/ �.
NAME
s
I
LEGAL LOT VARIANCE OR CONDITIONAL UBE
BUILDING
i
PROPOSED USE
PLUMBING
H
ADDRESS
(j YES NO PERMIT NUMBER
HEAT & GAS LINE
,
j
I
PLOT PLAN (Indicate Building setbacks, abutting streets)
FENCE
PLANNING DEPT. APPROVAL DATE:
SIGN
RETAINING WALL
CITY
TELEPHONE NUMBER
'
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
i
j
PRE -MOVE INSPECTION
NAME / 1
COMP. PLAN ST. R/W ^•^-•...
111��d
C�i�-�• 1' ham. �fj+�
REMARKS
I hereby acknowledge that I have read this application; that the In -
00
ADDFF-REII
SS
I
Iced agent of the owner. I agree to comply with city and elate law. reg.-
ATTENTION
APPLICATION APPROVAL
Q4
lating construction; and In doing the work authorlied thereby, no person
CHECKED BY
will beployed In vlolntlon of We Labor Code of the State of Washington
THUS PERMIT
This application is not a permit until
C/t�,iYTELEPHONE
NUMBER
relatingemto Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
j
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty: and fees are paid, and receipt is Be
TI
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
ImoWledged in space provided.
pleted in six months.)
S
STATE LI}}CEN/SSE NUMBER
C1TY LICENSE NUMBER
INSPECTION
Dl CTOR'e `$IONAT
j
) 1.
DEPARTMENT
i d j ;% i•"v7% / �'-
CITY OF
REMARKS
EDMONDS
DATE
_
' �
NOTE: Applicant Subject to Plan Check Fee
775-2525
Legal Description at Properly (Show Below of Attach Four Copies)
r
This Permit covers work to be done as private property ONLY.
1
Any conetructlan on the publle, domain (curbs, sidewalks, dfl—ys.
TYPE CONNECTION I VERIFIED BY
INSPECTOR
muse...., etc.) will reemre Separate permission.
H
�
P M' l3M
E
U
D
m
O
E
I
e
e
i
Ii
FIRE ZONE I TYPE OF CONSTRUCTION I STREET IMPROVED
1
i I
YES C] NO
'
SPECIAL INSPECTOR REQUIRED
I OCCUPANCY GROUP
i
GAS
❑ RESIDENTIAL ❑ LINE
❑ YES S, ❑ NO
IN THE CITY
❑ NEW
PLAN CHECKED BY
,THIS SITE IS LOCATED
'OF CAL SALES TAX
NON-RESIDENTIAL ❑ SIGN
EDMONDS.
SHOULD BE CODEDLO3104
I
❑ ADD
RWALL KING
REMARKS
.I
❑ DEMOLISH❑
;
E ❑ FENC........... Ft.)
❑ ALTER ❑ EXAVATORFILL
❑ REPAIR ❑ IN PbIOVE ❑ SWI I
POOL
NUMBER OF STORIES NUMBER OF
'
DWELLING
I
UNITS
NATURE OF WO K TC BE DONE "; i
Valuation
Fco Receipt Nov
- t/ �.
Plan Check Nn .....................
I
BUILDING
i
PROPOSED USE
PLUMBING
•)r 00
,
HEAT & GAS LINE
j
I
PLOT PLAN (Indicate Building setbacks, abutting streets)
FENCE
SIGN
RETAINING WALL
BNIMSIING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
" 1 1 / `s / / •li
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In -
forma"" given to correct; and that I am the owner, or the duly author.
I
Iced agent of the owner. I agree to comply with city and elate law. reg.-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorlied thereby, no person
will beployed In vlolntlon of We Labor Code of the State of Washington
THUS PERMIT
This application is not a permit until
,
relatingemto Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
j
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty: and fees are paid, and receipt is Be
shall be completed In ninety days; MOVED -IN BUILDINGS Shall be com-
ImoWledged in space provided.
pleted in six months.)
j
31GNATUI E_TOWNER OR AGENT), DATE SIGNED
INSPECTION
Dl CTOR'e `$IONAT
j
) 1.
DEPARTMENT
i d j ;% i•"v7% / �'-
CITY OF
EDMONDS
DATE
_
' �
NOTE: Applicant Subject to Plan Check Fee
775-2525
_)
__--
i ,.-•—"-' I
This Permit covers work to be done as private property ONLY.
Any conetructlan on the publle, domain (curbs, sidewalks, dfl—ys.
INSPECTOR
muse...., etc.) will reemre Separate permission.
,
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