740347.pdfe
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`••• BUILDING DEPARTMENT Applicant Fm ZONE �S • �� IN
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PERMIT APPLICATION Inside Heavy —es
NAME (OR NAME OF_ BUSINESS) _
MA1L1 Q ADDRE98 '
CITY T ."n, NUMHk:R
NAME' r
wAnnl�Etls y
JOB
ADDRESS
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PERMISSIBLE �p O
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AC'CUAI. �.
IAT COVERAGE a
LOT COVERAGE
PERMISSIBLE RIR:IiGDHFT`
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TPOI TFA 1, 1
REQUIRED Y
PROPOSE ARDS
FRONT R/
NRO
S�DRI
NAME
LggOAL LOT VAIIIANCE Olt CONDITIONAL Usk.
r-f.YE NO P RMIT NUMI)ER
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BONS UMBTER
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NAME
G STREET R/W ! FT. DEFICIENCY THIS PROPERTY
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COMP. PLAN BT. R/N ...... ..FT.-C'.FT•
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REMARKS Ill I ' ily
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CLEARANCE
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Legal Description of Property (BhowN/Below or Attach Four Coplce)
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TYPE NECTIrON V Ib E
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TPERMIT UMBER
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.FIRE'jLONE TYPB.-r/ CONT UCTION
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.- '1� .Y�'-..- lv'
— (�YEe [3 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY G UP
ESIDENTIAL
GA8.
PINE
❑ YES '(��NO
PVAN CHECKFD BY THIS SITE IS LOCATED IN THE CITY
NEN
FEJNON-RESIDENTIAL
EDMONDS. LOCAL SALES TAX
_
SIGN,
, -' / },,;. 9 ' ��.�'. -/: "-'" OH,
BE CODED 31.04.
ADD
�, SHOULD
REMARKS +
❑RETAINING
DEMOLISH -.WALL
- ..
ALTER EXCAVATE FENCE
OR FILL I .......... ..............)
PRE- OVE O awl
REPAIR
-..? (.' i.. i �/ i_- ! l— I,'i (%/✓ _� i /v J �i ✓.� !/_: C�!^':.:i'
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❑ POOL
NUbIBER OF STORIES NUMBER OF -'•
DWELLING
UNITS •- _
NATURE OF WORK TO BE DONE
- Valuation Foo Receipt No.
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Plan Check Nn .....................
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BUILDING
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PROPOSED UaE
PLUMBING
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PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
FENCE
SIGN
I
RETAINING WALL
N
SWIMMING POOL
i
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
% / , S �/
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I ( (/I 1 L
I hereby acknowledge that I have reed this application; that the In-
1
formnllon given Is correct; and lb., I am the owner, or the duly author-
Ired agent o[ the owner. I agree to comply with city and elate laws regu-
ATTENTION
APPLICATION APPROVAL
Iating construction; and In doles the work authorised thereby, no person
Will be employed In violation of the Labor Code of the State of Washington
TLIIe PER511T
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
hlch
NOTE: Permit Limit One Year (E:caDt DEMOLITIONS which
ONLY THE
WORH NOTED
and fees are paid, and receipt Is ac-
p
shall be Completed in ninety days; MOVED -IN BUILDINGS shall be com-
knowledged in space provided.
Pleted In six month,.)
', I I IN
SIGNATURE (OWNER OR AGENT)
DATE SIGNED r
INSPECTION
DEPARTMENT
D,,iiRECTOR'8 SIONATU ``
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J J
CITY OF
EDMOND9
DATE---–
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NOTE: Applicant Subject to Plan Check Fee
PR a-uov
This Penult coven work to be done on private property ONLY.
Any coastruetmn ca the pobllc domalP (eurbs, sldewelks, driveways,
INSPECTOR
marquee,, etc.) will require separate Permission.
`
Qo���D
RECORD OF INISPEC'f10yS �� ,
Date Passed
Foundation —1 7
4