740528.pdfUSERMIT
BUILDING DEPARTMENT Applicant Fill ZONE NUMBER % j
4- PERMIT APPLICATION Inside Ileavy Lines-ionwonnF.ss
NAME (OR NAME OF BUSINESS)PEI,rACTUALL 1t - LOT COVERAOFLOT COVERAin
A LLJ`�,CITY TELEPRONE NUMBER7.(ZC .TU NlJ ct .,C).
NAME Ff''IlO`N 1' NIDE REAR FRONT SIDE REAR
WLEGAL LOT VARIANCE OR CONDITIONAL SE
ADDRESS (A YES 0 NO PERMIT NUMBER i
h
PIANNffG EPT, PROVAL DA E:
CITY TELEPHONE NUMBER S ETR V ZO
EXISTING STREET R/t��K``,C ...�11r. DEFICIENCY T/^H�IS PROPERTY
NAME ` COMP. PLAN ST. R/ryc........ ......tJFT. lckbl
�7* REMARKS Driveway slopes not to exceed those ^p
AD 11. S
indicated on Standard Dw4 No 103 Iw
c QA In Y \.0A Y REG BY
CITY TELEPRONE NUMBER ng
-ell
I R -A rQl E, �� it METESSE eE IVICSIZE CLEARANCE C D BY
STATE L[CENSE NUMB R I CITY LICENSE NUMBER / I E I
"D+] �1t G l L(� ItEMARRU
Legal Description of Properly (Show Below or Attach Four Copies) I-altie ' 4—e �J
k. (v'iT TYPE CONNECTION ( VERIFI D BY i
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PEIiG. TEST P9R2Q1qUIdBER �
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REMARKS 'A
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W FIRE ZONE TYPE OF CONST UCTION STREET IMPROVED
_
W,15S 0 N
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
® RESIDENTIAL OAS YES
❑tt'�� I
LINE PLAN CHECKED YT
HIS SITE IS LOCATED IN THE CITY
® NEW ❑ NON-RESIDENTIAL slcN OF EDMONDS. LOCAL SALES TAXI
❑ ADD RETAINING w Ks H LD BE CODED 31.04.
EXCAVDEMOLATE
WALL
ALTER EXCAVATT E FENCE
❑ OR FILL � (......... .i ..........
Fl.) - �r
E] REPAIR ❑ SWIM
INPafOVE ElPOOL �J (/{�t(G V� /Z)Vxi
NUMBER OF STORIES NUMBER OF
DWELLING '
'( l ri 9lir UMTS
NATURE OF WORK TO BE DONE Valuation Fee Recelpt No.
Plan Che.ck No ..................... '.
O BUILDING fT�y (� 0,
PROPOSED USE 0 re–a a .
PLUMBING `r S
U
M PLOT PLAN (Indicate Building setbacks, abutting street.) HEAT A GAS LINE 9 S-
� FENCE
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that lha In. aJ '
formation given Is correct: and that I am the owner, or the duly author -
Ned agent of the owner. I agree to comply with city and state laws regu- ATTENTION APPLICATION APPROVAL
biting construction; and In dolag the work aulhorUld thereby, no person
will be employed In violation of the Labor Code of the Slate of Washington THIS PERMIT This application Is not a permit until
rela[lag to Workmen's Compensation Insurance. AUTHOFill
ZE8 signed by the Building Official or his Dep -
ONLY TE
NOTE: Permit limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
ehail be completed In ninety days; 31OVED-IN BUILDINGS .hail be cam- IIIl ledged in space provided.
Pleted In elf month-.)
81G7.
L)))TUIiE (OWNER OR AGENT) DATE SIGNED INSPECTION IREC OHIO SIO2)l/.TUR
// • Io_ DEPARTMENT �//
7 CITY OF
r EDMONDS ATE %.
NOTE: Applicant Subject to Plan Check Fee "---
775-2525
Title Penult a ark to be done on private Properly ONLY.
Any eunslructlnrt on tile Public domain (curbs, sidewalks, driveways' FILE
nmraueee, etc.) will r"ulre separate permledon.
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ZONE. ( , NUMBER r 4v J'
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BUILDING .DEPARTMENT 48
Applicant Flu USE ' , PERMIT
PERMIT APPLICATION Inside Ileavy Linos
NAME (OR NAME OF BUSINESS)
is
MAILING ADOREBtl
CITYTELEPHONE NUMIAR
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NAAIC
WADDRESS
F
AUUREBS
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PEIMISH )°. r
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IT COVERAGE ('
ACTUAL
LOT COVE, AGE
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11O108ED HEIG1HT/
it)
AcT A , LOT AREA
TOTAL DLDO
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rEA
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— REQUI -1 YARUH
PROPOSED YARDS
FRON —ID VREAR
FRONT SID�EI REAR
EXISTING STREET R/7v DEFICIENCY TH78 PROPERTY
'1 /,c��� /'\
COMM PLAN BT. R/W W
!�.f �i i:`.( II'., 1,((.., �11 ),.t.`
'
LFrIA I, 1.00 VARIANCE OR CONDITIONAL UBE
0 YRS NO PERMIT NUMBER
'
' .A E API-ROVAL 0�A'1'E_:
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CITY U IEIt
it)
<y'
STREET R/V
NAMEr
EXISTING STREET R/7v DEFICIENCY TH78 PROPERTY
'1 /,c��� /'\
COMM PLAN BT. R/W W
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'
..:.i.::.::p'T. .......S..:FT.
RFMAR" 11.x.' il'5+
t'ei'!ay slopes not to exceed t:Lo�•
m
ADOREHe
on Standard '1!o.`1 ',`�
o
1
I... t `r r
BY
L'Y
.I I O FIN llBEft
I
l
At E'rEtiBIZE eERVICE SIZE CLEARANCE
CI-IE(�` D BY
STATE LICENSE NUMBER
I'r F:NtlE♦• MDER
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REnwtxe
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Leg¢I Deecrl Pilon of 14o1wrlY ltllmw Bcluw or Attach Four CuVlcr!J
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ci%
TYPE CONNECTION VERIFl D BY
I
y
FERC. TEST..
.. BER
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rttq���
ne
, 1
FIRE ZONE 'UP11` OF STR CT1 N—
MPROVED
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
❑'' Itl•:SIDF.NTIAL
GAS
El
❑ YES 0 tt•10
NEW
❑
LINE
c THIS SITE IS LOCATED IN THE CITY
PLANC1iECK'D /By
/-OF EDMONDS. LOCAL SALES TAX
NON-RESIDENTIAL
❑ BION
,; Li -"-'t'' SHOULD BE CODED 31.04.
- '-
❑ ADD RETAINING
❑ ❑ PALL
t.-
REMARX9
Ii%CAVA1'E FENCE
❑ EXCAVATE
/ ! (,. r-
•�,'�' /:�
YL // y
AI.TEIt ❑
OR FILL (..........x..........Ft.)
❑
❑ liF:I',1IR PnE-SWIM
INSP.' VF. POOL
_ r �/C_"-'- •cfi it'-�-"
N AI IIRH OF' BTUIII I:H NUMBER OF
DWELLING
UNITS
NATURE OF IVURIC TV DE DONE
-
Valuation
Fee
Receipt No.
Plan Check No .....................
j
rO.
BUILDING
,f
'_i .�1�.1Y
/.J,1 'i-
PItUPCSED USE
PLUMBING
/
OT PLAN (Indlanlo IIullding setbacks, abutUe. et recta)
HEAT & GAS LINE
C/ c) .._ -
5
FENCE
SIGN
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
-
I hereby acknowledge that I have read this application; that the in.
formation given la correct; and that I am the owner, or the duly author -
,_i sent ¢1 the owner. I agree to comply with city and state Iowa raga-
ATTENTION
APPLICATION APPROVAL
Isting construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Cade of the State of Wnebington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTROnIZES
Signed by the Building Official Or his Dep -
NOTE: Permit limit One Year (Except DE51OLITIONS whlclt
THE
ONLY OTE
WORH NOTED
ut and fees are aid, and receipt is ac-
Yi P P
shall ae completed In Nasty d¢ya; MOVED -IN BUILDINGS shall be aom•
knowledged In apace provided.
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE 81GNED
INSPECTION
DIRECTOR'S SIGNATURE
'
DEPARTMENT
-
CITY OF
NOTE: Al plicant SrlGiect to Plan CGcrk Fee
EDNIOWDS
DATE
-!-
�
i 775.2525
Thle Permit c work M be done an Prlt'nle Dra petty ONLY.
driveways,
Any <onelncem.' on Ilre public demotequine (carat, permisks,sion.
nmrauees, etc.) will require aepnrnte Permltslon. ,
INSPECTOR