740411.pdf_
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USE PERMIT % /� (i /�
NUMBER r YI J T
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PERMIT APPLICATION
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NAME (on N M OF UUHINEBB) 1...���j 1 1rJ
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LOT COVERAGE LOT COVERAGE
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MAS/IjLINJG� ADDRESSPERMISSIBLE HEIGHT PROPOSED HEIGHT
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TELEPHONE NUMBER ACTUAL
NUMBER OF
REQUIRED YARDS PROPOSED YARDS
FRONT S[DE REAR
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2 DEMOLITION
DWELL NO
FRONT BIDE REAR
NAME
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VARIA NCh. NDITIONAL USE
LEGAL LOT OR CO
PRE -MOVE INSPECTION
ADDRESS 0 YES 0 NO PERMIT NUMBER
VATUREOFF WORK TOO BE DONE
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PLANNING DEPT. APPROVAL DATE:
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CITY TELEPHONE NUMBER
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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(zed agent of the owner. I agree to comply with city and stale lawn regu-
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of Ne Labor Code of the Stale of Washington THIS PERMIT
NAMEId
1 �S COMP. PLAN BT. R/W ............fT. ............FT.
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relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY TH
NOTE: Permit limit One Year (Except DEMOLITIONS which Wons: NOTED
hall
-hallbe completed In ninety days; MOVED -IN BUILDINGS shall be was.
Signed by the Building Official Or his Dep -
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
C) WIV C"I REMARKS
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(OWNER OR AGENT) DATE SIGNED INSPECTION
t _ DEPARTMENT
ADDRESS
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BY
This 1'emul Cos'en work Io be dune an prit'rtle praperlY ONLY.
(CHECKED
CITY TELEPRONE NUMBER
FILE
N
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I METER 8fLE .-.VICE SIZE CLEARANCE CHECKED BY
V
STATE LICENSE NUMBER I
CITY LICENSE NUMBER
I
REMARKS
Legal De11"Jillan 11 Praparlyy{ "I Below or Attach Four Copies) ` 1
L v^r; a -F rJ
TYPE CONNECTION VERIFIED BY
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PERO. TEST
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PERMIT NUMBER
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r REMARKS
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RESIDENTIAL
FIRE ZON TYPE OF CONSTRUCTI STREET IMPROVED
AS
LINE
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9 CIAL//L�INSPECTOR REQUIRED
OCCUPANCY GROUP
-
❑ YES ❑
❑
NON-RESIDENTIAL
❑
SIGN
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ADD ❑
DEMOLISH
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yEALL NTNG
ALTER ❑
onOFILLTE
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REPAIR ❑
IN PSIOVE
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POOL
IUMBER OF STORIES
NUMBER OF
2 DEMOLITION
DWELL NO
1
UNITS
PRE -MOVE INSPECTION
WHl_NU� S i EXCAVATION OR FILL
VATUREOFF WORK TOO BE DONE
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Plan Check No.....................too
BUILDING
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FIRE ZON TYPE OF CONSTRUCTI STREET IMPROVED
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YES 0 NO
9 CIAL//L�INSPECTOR REQUIRED
OCCUPANCY GROUP
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❑ YES ❑
V
aPLOT PLAN (Indicate Building setbacks, abutting streets) HEAT a: GAS LINE
PLAN CHECKED Y
THIS SITE IS LOCATED IN THE CITY
'
OF EDMONDS. LOCAL SALES TAX
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FENCE
SHOULD BE CODED 31.04.
REMARKS
RETAINING WALL
Plan Check No.....................too
BUILDING
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c/
W PROPOSED USE
'a PLUMBING
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aPLOT PLAN (Indicate Building setbacks, abutting streets) HEAT a: GAS LINE
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FENCE
5 SIGN
RETAINING WALL
µOUSE /
SWIMMING POOL
2 DEMOLITION
PRE -MOVE INSPECTION
WHl_NU� S i EXCAVATION OR FILL
II
TOTAL AMOUNT DUE
I hereby acknowledge that I Gnus read t61e nDpllentlan; that the 1n -
Iormntlan given Is enrrect; and that I area the owner, or the duly author-
ri
(zed agent of the owner. I agree to comply with city and stale lawn regu-
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of Ne Labor Code of the Stale of Washington THIS PERMIT
This application is not a perralt until
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY TH
NOTE: Permit limit One Year (Except DEMOLITIONS which Wons: NOTED
hall
-hallbe completed In ninety days; MOVED -IN BUILDINGS shall be was.
Signed by the Building Official Or his Dep -
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
pleted in elx months.)
(OWNER OR AGENT) DATE SIGNED INSPECTION
t _ DEPARTMENT
DIRE URE
J- ,.Q,..�,t_z�Yl/ f �.S J CITY OF
EDIIIONDS
NOTE: Applicant Sujcct to Plan Check Fee
775-2525
Vs
DATE +yy
7 —�Ij /
This 1'emul Cos'en work Io be dune an prit'rtle praperlY ONLY.
Any construction on ilio public domain (curbs, sidewalks, driveways,
marquees, etc.) uu,111requlre separate pefnllulon.
FILE
C11
USE„. PERMIT
4
BUILDING DEPARTMENT npplleant Fm ZONE25
L NUMBER
PERMIT APPLICATION inside Heavy Linea JOB
- ADDRESS
NAME (OR NAME OF BUSINESS) -/ /,
l/ � )"1 L�t�t ♦c i
PRMISSIBLE %. ACTUAL J
•� �_. � l_ i'� � _ I
LET COVERAGE LOT COVERAGE ,
MAiLINO ADDRESSv
i PERMISSIBLE HEIGHT PROPOSED HEIGHT
C l '
TELEPHONE NUMBER ACTUAL LOT AREA TOTAL BLDG. AREA
CITY I
REQUIRED YARD H PROPOSED YARDS
NAME FRONT SIDE REAR FRONT SIDEREAR
LEGAL LOT VARIANCE OR CONDITIONAL USE I 1
yF ADDRESS YES 0 NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
C CITY I TELEPHONE NUMBER
c STREET R/IV p
' EXISTING eTREET R/N ............FT. DEFICIENCY THIS PROPERTY
NAMEy
CODfP. PLAN 8T. R/W ............FT. ............FT, W
tlj o C 1 �- RIIMARKB �+
ld ADDRESS i
CHECKED BY
CITY 11 TELEPHONE NUMBER
O METER SIZE I SERVICE SIZE I CLEARANCE I CHECKED BY
O STATE LICENSE NUMBER I CITY LICENSE NUMBER y'
REMARKS / i
Legal Description of Properly (Show Below or Attach Four Copies) A ' /
_ d1 1v _
4 TYPE CONNECTION VERIFIED BY
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�+ PERC. TEST PERMIT NUMBER aiC I j
REMARKS w
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67 FIRE ZONE TYPE OF CONSTRUCTION aTREET IMPROVED
a r 1
` 1 — fV ❑ YES [:I NO I
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
AS C] YES [I,” fn
NEW � RESIDENTIAL � GLINE PLAN CHECKED ➢Y THIS SITE IS LOCATED IN THE CITY �
NON-RESIDENTIAL a1cN OF EDMONDS. LOCAL SALES TAX
aASHOULD BE CODEI'D731.04.
DD RETAINING REMARKS
0 DEMOLISH WALT
❑FENCE 11, ,\.1. 1111."✓'N, f�11�� •�\ ( ��•t' {
ALTER ❑ OR FILLTE (......... .x ......... Ft.)
❑ REPAIR PRE -MOVE D SWIM
INSP. POOL
NUMBER OF STORIES NUMBER OF
DWELLING
'1 UNITS
NATURE OF WORK TO BE DONE Valuation Fee Reecipt No.
O V ( 1 c
•- Pion Cheek No .....................
O BUILDING !.Z% / }, dv
c. PROPOSED USE
PLUMBING
U
M PLOT PLAN (Indicate Bulls t ec ` .U.g etre...) HEAT A GAS LINE
� , I FENCE �Ii
SIGN '
RETAINING WALL
4 I SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
I
T
EXCAVATION OR FILL
I
'a f)
TOTAL A3130DNT DUF.
I hcrcby acknowledge that I have read this application; that the In-
faramth" given Is correct; and that I am, the owner, or the duly author-
I.1d agent of the owner. I agree to comply with city and state lawn regu-
ATTENTION
APPLICATION APPROVAL
laling construction; and In doing the work authorlred thereby, no person
will be employed In violation of the Labor Cade of the State of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compeneatlao Inauranee.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac -
shall be completed In ninety days; 31OVED-IN BUILDINGS shall he cam-
knowledged in space provided,
pleted In six months.)
31ONATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DIRECTOR'a,SIG) A.TURE f
I
DEPARTMENT
_ !
4' C
CITY OF
�.
EDIILONDB
DATE
NOTE: Applicant Subject to Plan Check Pce
775.2525
This P. olt covers work to be sane on Private Property ONLY.
Any cenelruetlon on the public dmnedu (curbs, eldewalke, drieewye,
INSPECTOR
nmpures, etc.) will ire .....parole P_d..lon.