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BUILDING DEPARTMENT Applicant FLU z°`E UMBER 740251
PERMIT APPLICATION Inside Heavy Lines—i—off—
ADDRESS
A /f
ADDRESS a
INAµ`.�` (OH rids OF SUSINEB PERMISSIBLE -/Y' -efJ AGCTUAL /�
\\ n � LOT COVERAGE LOT COVE
U
O
��,_�_ 'ACTUAL
TYPE OF CONSTRUCTION STREET IMPROVED
I
TELEPHONE NU.11A
LOT AREA
TOTAL DLDO. AREA
UA- I
REQUIRED YARU9
PROPOSED YARDS
BIDE REAR
FRONT BIDE REAR
REQUIRED
GROUPEl
FRONT
RESIDENTIAL
LEGAL LOT VARIANCE
OR CONDITIONAL USE
(OCCUPANCY
IS LOCATED IN THE CITY
C3 YES [] NO PERMIT NUMBER
NEW
PLANNING DEPT. APPROVAL
DATE:
THIS SITE
OF EDMONDS. LOCAL SALES TAX
NUMBER
(TELEPHONE
STREET R/W
EXISTING STREET R/W ............FT.
OF THIS PROPERTY
SHOULD BE CODED 31.04.
COMP. PLAN ST. R/W ............FT.
............FT.
In 011_/
❑ RETAINING
REMARKS
FIRE ZONE
TYPE OF CONSTRUCTION STREET IMPROVED
I
�
; I
I
I
YES E] NO
SPECIAL INSPECTOR
REQUIRED
GROUPEl
j
RESIDENTIAL
CAS
INE
❑ YES C] NO
BY
(OCCUPANCY
IS LOCATED IN THE CITY
NEW
PLAN CHECKED
THIS SITE
OF EDMONDS. LOCAL SALES TAX
NON-RESIDENTIAL
❑ SIGN
SHOULD BE CODED 31.04.
❑ ADD
❑ RETAINING
REMARKS
I i
❑ DEMOLISH WAIT'
ALTER ❑ EXCAVATE FENCE
OR FILL (..........x..........Fl.)
i
❑ REPAIR ❑ INSPPRE-MOVE El POOL
1 i
NUMBER -OF STORIES NUaiBER OF
DWELLING
I
UNITS
NATURE OF WORK TO BE DONE
Valuation
Fee Receipt No.
1 I
Pian Check N. .....................
i
BUILDIN°
PROPOSED USE
PLUMBING
J EJJf 1
HEAT do GAS LINE
PLOT PLAN (1adicale Building setbacks, abutting streets)
FENCE
i
SIGN
RETAINING WALL
N
1
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
i hereby acknowledge that I hove read this application; that the In-
! '
tormnuon given Ie correct; and that I am the owner, or the duly author -
1d agent of the owner. I agree to comply with city and state law. regu-
ATTENTION
APPLICATION APPROVAL
;
laling construction; and In doing the work authorized thereby, no person
will be amPiaYad In vlegatimi of the Labor Code of the State of Washington
THIS PERMIT
This Application is not a permit until
relatlug to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official Or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THEUty;
WORK NOTED
and fees are paid. and receipt Is Be
'
shall be completed In ninety days; MOVED -IN BUILDINGS shall be cam-
knowledged in space provided.
)
ONDATE9[GNED
INSPECTION
DEPARTMENT
DI$3�TOR'e SIGNAT
�(ONERCO:��_
I
` (O-7
CITY OF
DA E
Fre
EDMONDS
54
NOTE: Applicant Subject t° Plan Check
775-2525
This Permit aovrr. work to be done n prWote Properly ONLY.
Any c...truation en the public Lat.ln (..the, eldewNke, drivew►Y.,
FILE
'
mnrqueen, rta.) will repWre eePar.le Permleelon.
I
USE
PERMIT
E BUILDING DEPARTMENT Appllcant ZONE OM `
LIneo Heavy ADDRESS 1,
PERMIT APPLICATION
Mlr(OR NAME 1,404
' 0r"
PERMIedIBLE mt ACAL
LOT COV
_iA
OELOT COVEII.0
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MAll d�ADDREde 1 3L HER TROP. E H some O
¢ PERMIddlDLE HEIOIST PROPOSED HEIGHT z
FRONT SIDE REAR FRONT BIDE REAR
LEGAL LOT VARIANCE Olt CONDITIONAL USE
O YES El
NG PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
STREET It/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
E
NOTE: Applicant SriGject to Pfau Check Fee '-
775.2525
This Permit e—re work to be done on private property ONLY. /
Any construction on Ilia public domain (curbs, sidewalks, driveways, INSPECTOR
marquees, etc.) will require 6eptrale permission.
Plan Cheek No .....................
YES ❑ NO
I'
BUILDING
SPECIAL INSPECTOR REQUIRED
I OCCUPANCY GROUP
PROPOSED USE \
GAS
LINE
❑PLANS CHECKED [3BYO
THIS SITE IS LOCATED IN THE CITY
❑ NEW
ff..SIDENTIAL
NON-RESIDENTIAL
SIGN
OF EDMONDS. LOCAL SALES TAX
ADD
PLOT PLAN (Indl m� u8ding a tbatks, abutting streets)
HEAT A GAS LINE
REMARKS
SHOULD EE CODED 31.04.
FENCE
❑WCTLA,ININC
DEMOLISH
Li
I
ALTER
❑
CTE
ORFILL
❑
ENC
(X.......... Ft.).
REPAIR
❑
❑
SWI I
ISWIMMING
POOL
NP.
POOL
DUMBER OF STORIES
NUMBER OF
PRE -MOVE INSPECTION
i
EXCAVATION OR FILL
DWELLING
I
i
UNITS
TOTAL AMOUNT DUE
I hereat' acknowledge that I have recd this application; that the !n-
NATURE OF WORK TO BE DONE
.
formation given Is correct; and that I em the owner, or the duly author.
I
Valuation Far Race
E
NOTE: Applicant SriGject to Pfau Check Fee '-
775.2525
This Permit e—re work to be done on private property ONLY. /
Any construction on Ilia public domain (curbs, sidewalks, driveways, INSPECTOR
marquees, etc.) will require 6eptrale permission.
Plan Cheek No .....................
I'
BUILDING
PROPOSED USE \
/ 1
PLUMBING
PLOT PLAN (Indl m� u8ding a tbatks, abutting streets)
HEAT A GAS LINE
i
FENCE
SIGN
RETAINING WALL
N
ISWIMMING
POOL
-
DEMOLITION
PRE -MOVE INSPECTION
i
EXCAVATION OR FILL
i
TOTAL AMOUNT DUE
I hereat' acknowledge that I have recd this application; that the !n-
{
.
formation given Is correct; and that I em the owner, or the duly author.
�-
Ized agent of the owner. I agree to comply with city and elate laws regu-
ATTENTION
APPLICATION APPROVAL.
lating construction; and In doing the work authorized thereby, no person
willbe employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
,
relaupg to Workmen's Compensation insurance.
AUTIWRIZE13
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DE59OLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is Be
ahall be completed In nicely days; 2110VED-IN BUILDINGS shall be cum-
knowledged in space provided.
plated In six months.)
RONATURE (OWNER Olt AGENT)., DATE SIGNED
INSPECTIONDIREC}•S
SIRA
'TURFei
-
DEPARTMENT
-
L.;xL c-., .: ) _,
CITY OF
moi/
D➢fONDB
DATE
E
NOTE: Applicant SriGject to Pfau Check Fee '-
775.2525
This Permit e—re work to be done on private property ONLY. /
Any construction on Ilia public domain (curbs, sidewalks, driveways, INSPECTOR
marquees, etc.) will require 6eptrale permission.