740313.pdf`
40313
BUILDING D E P A R T M E N T Applicant Fill
USE
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PERMIT
NUMBER
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NAME lOR NAME OF BUSINESS)`�
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ACTUAL LOT AREA
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CITY TELEPHONE
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REQUIRED YARDS
PROPOSED Y.hRDS
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NAME
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LEOA1. 3.OT ARIANCE OR CONDITIONAL USE
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PLANNINp' E1�ppPit°yAL DATE:
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TELEPHONE NUMBER
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EXISTING STREET R/N ..........f'I.
DEFICIENCY TfiIB PROPERTY
NAME
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COMP. PLAN ST. A/W ........,.FT.
REMARKS
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ADDRESS
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CHECKED BY
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CLICENSE NUMBER
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REMARKS
Legal Description Or 11apoNy (Snow Below or Attach Four Copies)
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TYPE CONNECTION
VERIFIED BY
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PEItC. TEST
PERMIT NUMBER
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REMARKS
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aFIRE
ZONE OF CONSTRUCTION STREET IMPROVED
(TYPE
YES [] NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
RESIDENTIAL
CAB
LINE
❑ YES ❑ NO
NEN
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
TAX
i
❑ NON-RESIDENTIAL
SIGN
OF EDMONDS. LOCAL SALES
BE CODED 31.04.
naD
RETAINING
REMARKS
SHOULD
DEMOLISH WAIT
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ALTER AVATE ❑ FEN C
❑ ORCFILL x .......... Ft.)
REPAIR PRE-MOVESWIEI
❑ INSP. El POOL
NUMBER OF STORIES NUMBER OF
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DN ELLING
-
UNITS
NATURE OF WORK TO DE DONE
Valuation
Fee Receipt No,
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Plan Check NO..... ................
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BUILDING
Or
PROP08E. UBE
PLUMBING
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41
PLOT PLAN (Indicate, Building setbacks, abutting streets)
HEAT Sr GAS LINE
2121
FENCE
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SIGN
RETAINING WALL
II
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SWIMMING POOL
DEMOLITION
1
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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2410 17
TOTAL AMOUNT DUE
I hereby acknowledge that I have reed this application: that We In-
formation given Is correct; And that I Am the owner, or the duly aulhor-
Izcd agent of the owner. I agree to comply with city and elate I.W. rego-
ATTENTION
APPLICATION APPROVAL
laUng conetructlon; and in doing the work authorized thereby, no person
Will be employed in violation of the Labor Code of the Stale of Washington
THIS PERMIT
This application is not a permit until
1
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except nEMOLIT10N8 which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac -
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
knowledged in space provided.
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE BIGNED
INSPECTION
DEPARTMENT
DIRE '8 S1OTURE .,-
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1.
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(/l-.U7u
-
CITY OFV✓L
EUMONDS
NOTE: A(hlirant Subject to Plan Check Fee
775-2525
This I'ermH rr work to be done on private property ONLY.
Any construct tan anthe public domain (curbs, sidewalks, drh'eways,
FILE
marquees, etc.) x'111 require separate pennlsslon.
Man Cher ....................
- k No
BUILDING
PROPOSED UBE
PLUMBING
PLOT PLAN (Indlonte BulldinggC setback((e��n\buIII street.) HEAT & GAS LINE
o C �
FENCE
I'
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I
TOTAL AMODNT DUE �'� I/rj -7
cI�
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.
fred agent of the owner. I agree to comply with city and state law. regu• ATTENTION APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby. no person
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT This application Is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the BuildingOfficial or his De
ONLY THE p
NOTE: Permit Limit One Year (Except DEMOLITIONS whish WORK NOTED uty; and fees are paid, and receipt Is nC-
shallplete be completed In ninety days; 810VED-IN BUILDINGS shall 6e cam- knowledged In space provided.
pleted In six month..)
SIGNATUItE (OWNER OR AGENT) I DATE SIGNED INSPECTION DI TOR'S IGNAT1)GG
/- DEPARTMENT
%i. • .i:' _ y / ' ji���,. CITY OF
.. , . EDMONDS DATE
NOTE: Applicant Subject to Plan Check Fce � � � — � q I
Thle Permit euyere work to he done on private DroMr1Y ONLY. 775-2525
Any construction on the Public domain (curbs, sidewalks, drlvewU'e,
marquees, etc.) will require separate permission. INSPECTOR
O
USE PERMIT
BUILDING DEPARTMENT Appilemt Fla
ZONE NUMBER
PERMIT APPLICATION I Inside Heavy Lines
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NAME NAME OF BUSINESS)
ADDRESS y t J
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REMARKS
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(OR
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ACTUAL /
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LOT C VERA
LOT COVERAGE LOT COVERAGE
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FIRE ZONE TYPE OF
CONSTRUCTION STREET IMPROVED
MAII.ING•ADDRESS
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I
PERMISSIBLE HEIGHT PROPOSED HEIGHT
-
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CITY•
I TELEPHONE NUMBER
ACTUAL LOT AREA TOTAL BLDG. AREA
z
/,•/.�
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
CH EDMONDS. LOCAL SALES TAX
SHOULD 8E CODED 31.04.
REQUIRED YARDS PROPOSED YARDS
REPAIR
❑ on FILL
❑ INSPhIOVE
NAME
FRONT SIDE REAR FRONT SIDE REAR
NUMBER OF STORIES NUMBER OF
ADDRESS
LEGAL LOT VARIANCE OR CONDITIONAL USE
Iy
W
13 YES NO PERMIT NUMBER
UMTS
C CITY
TELEPHONE NUMBER
PLANNING DEPT. APPROVAL DATE:
Fee
i
!
STREET R/W'�'
O
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME
'.
G ✓ -,A .:'
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
ADDRESS
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/• %/•.;� /%�• I,~��f'-�'
x
!d
CITY TELEPHONE NUMBER
CHECKED BY
M
;A/1
'. %I r? .•.//SE
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
CENSE NUMB
8T'1'E LIyE�R/
'/'��:',^^/�/fin✓:/�
CITY LICENSE NUMBER
I I
Id
Legal Description of Property (Show Below or Attach Four Copies)
REMARKS
r
Man Cher ....................
- k No
BUILDING
PROPOSED UBE
PLUMBING
PLOT PLAN (Indlonte BulldinggC setback((e��n\buIII street.) HEAT & GAS LINE
o C �
FENCE
I'
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I
TOTAL AMODNT DUE �'� I/rj -7
cI�
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.
fred agent of the owner. I agree to comply with city and state law. regu• ATTENTION APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby. no person
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT This application Is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the BuildingOfficial or his De
ONLY THE p
NOTE: Permit Limit One Year (Except DEMOLITIONS whish WORK NOTED uty; and fees are paid, and receipt Is nC-
shallplete be completed In ninety days; 810VED-IN BUILDINGS shall 6e cam- knowledged In space provided.
pleted In six month..)
SIGNATUItE (OWNER OR AGENT) I DATE SIGNED INSPECTION DI TOR'S IGNAT1)GG
/- DEPARTMENT
%i. • .i:' _ y / ' ji���,. CITY OF
.. , . EDMONDS DATE
NOTE: Applicant Subject to Plan Check Fce � � � — � q I
Thle Permit euyere work to he done on private DroMr1Y ONLY. 775-2525
Any construction on the Public domain (curbs, sidewalks, drlvewU'e,
marquees, etc.) will require separate permission. INSPECTOR
O
d,
PERC. TEST
PERMIT NUMBER
M
m
W
O
REMARKS
.1
d
O
a
FIRE ZONE TYPE OF
CONSTRUCTION STREET IMPROVED
I
Q YES ❑ NO
-
SPECIAL INSPECTOR REQUIRED -11 OCCUPANCY GROUP
[IYES 11 NO
RESIDENTIAL E] GAS
❑ NEWJF� LINE
NON-RESIDENTIAL s1aN
ElADD RETAINING
❑ DEMOLISH WALL
ALTER EXCAVATE ❑ FENCx
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
CH EDMONDS. LOCAL SALES TAX
SHOULD 8E CODED 31.04.
REMARKS
REPAIR
❑ on FILL
❑ INSPhIOVE
❑
.......... Ft.,
POOL
NUMBER OF STORIES NUMBER OF
DWELLING
I
UMTS
NATURE OF WORK TO BE DONE
Valunllon
Fee
Receipt No.
Man Cher ....................
- k No
BUILDING
PROPOSED UBE
PLUMBING
PLOT PLAN (Indlonte BulldinggC setback((e��n\buIII street.) HEAT & GAS LINE
o C �
FENCE
I'
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I
TOTAL AMODNT DUE �'� I/rj -7
cI�
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.
fred agent of the owner. I agree to comply with city and state law. regu• ATTENTION APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby. no person
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT This application Is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the BuildingOfficial or his De
ONLY THE p
NOTE: Permit Limit One Year (Except DEMOLITIONS whish WORK NOTED uty; and fees are paid, and receipt Is nC-
shallplete be completed In ninety days; 810VED-IN BUILDINGS shall 6e cam- knowledged In space provided.
pleted In six month..)
SIGNATUItE (OWNER OR AGENT) I DATE SIGNED INSPECTION DI TOR'S IGNAT1)GG
/- DEPARTMENT
%i. • .i:' _ y / ' ji���,. CITY OF
.. , . EDMONDS DATE
NOTE: Applicant Subject to Plan Check Fce � � � — � q I
Thle Permit euyere work to he done on private DroMr1Y ONLY. 775-2525
Any construction on the Public domain (curbs, sidewalks, drlvewU'e,
marquees, etc.) will require separate permission. INSPECTOR