740566.pdf_ r
PERMIT
BUILDING DEPARTMENT Applicant Fill ONE �1 r NUMBER 740566
PERMIT APPLICATION
Inside Heavy Lines ADDRESS
NAME (OR NAME OF BUSINESS)
rJu ✓ PERMISSIBLE 71 ACTUAL /
B
MAILING P R V P,rtry IA) LOT COVERAGE LOT COVERAGE G
C
e 14 2 NG ADDRESS
d
y_
SPECIAL INSPECTOR
PERMISSIBLE HE70�/ PROPOSED
❑ YES NO
31 � - S-
�OHT
ZP
PLAN CHECKE BY
THIS SITE IS LOCATED IN THE CITY
C
CITY
TELEPHJNUMBER
ACTUAL LOT AR TOTAL
ss tU�f a
ARK
SHOULD BE CODED 31.04.
DEMOLISH El WAIL
FYI EXCAVATE FENCE
REOUift YARDS PROPO E ARDSNAMERONT
ALTER ❑
❑
OR FILL f........... .......... F1.)PRE-
REPAIR ❑ SWIM
O
/r 7y- .�,�
INSPAfOVE
POOL
BIDE REAR FRONT BIDE REAR
O
NUISIIER OF STORIES
NUSiIIER OF
L
DWELLING
IU 'Ij
UNITS
`
Valuation Fee Receipt No.
LEGAL L VARIANCE OR CONDITIONAL UBE
U r 4tA/A: (,J,+,, C�uffAUC
Plan Check NO .....................
v� 1IF6
r.
�1Oa
ADDREBB
® YES O NO PERMIT NUMBERPLA
r3
4 PROPOSED B
aPLUMBING
Re-i.>•/� SAS
NIN PT. ACITY
es
HEAT & GAB LINE
.f—
j
PLOT PLAN (Indicate Building setbacks, abutting streets)
TELEPH
J -._-
C
FENCE
0.
SIGN
STREET R/W
p
RETAINING WALL
I
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
SWIMMING POOL
I
DEMOLITION
NAME
I //��
ed
COMP. PLAN BT. R/W ............FT. ............FT.
W
1
EXCAVATION OR FILL
/11 U IZ S K Al S+
REMARKS
TOTAL AMOUNT DUE
2
jD 80 q/0
/
C
ADDRESS
.44
rLJ
t '
W
{(
Ized agent of tho owner. 1 agree to comply with clly and state taws regu-
8th/u t�
APPLICATION APPROVAL
CHECKED BY
Will be employed In violation of the Labor Code of the Slate of Washington
C
CITY-//
T-E7LEPHONE NUMBER
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS Which
ONLY THE
WORE NOTED
fees are paid, and receipt is ac -
.hall be comPlcted In ninety days: MOVEIII-1N 13ULLDINOS Shall be corn.
�G{Nr4ND)
7�-/a//T Z
I
pitted In six months.)
81ONATUItE (OWN fl O AGENT) DATE SIGNED
INSPECTION
V
�_�'CITYOF'IYA
/
METER SIZE SERVICE SIZE CLEARANCE
CIMCKED BY
NOTE: Applicant Subject to Plan Check Fee
EDMONDS
775-2525
STATE LICENSE NUMBER
CITY LICENSE NUMBER
coast (e
Any <nnst rueRnn on Ib public domain ...iden'ulks, drit nn'aye,
FILE
rli.l „III rr,nurc .rl�nralr lirr,nl.nlnn. �
I'a
_
REMARKS
C
Legal Description of Prope//rttty (K//now Below
or Attach Four Copies)
TYPE CONNECTION
VERIFIED BY
�.
AND /04- 3 4154 A�<K 120
PERC. TEST
PERIfIT NUMBER
C
O
I
l
REMARKS
�
O
E"X /•S✓ /�I/6
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
rflyEB [I NO
SPECIAL INSPECTOR
U RED OCCUPANCY GROUP
❑ YES NO
) � 2-i
ii
RESIDENTIAL OAe
LINE
NEN
PLAN CHECKE BY
THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL SIGN
�
OF EDMONDS. LOCAL SALES TAX
FADD RETAINING
ARK
SHOULD BE CODED 31.04.
DEMOLISH El WAIL
FYI EXCAVATE FENCE
/J,l
n �r/Sreyi://O/y /,: � UOl/ z773 73
ALTER ❑
❑
OR FILL f........... .......... F1.)PRE-
REPAIR ❑ SWIM
O
/r 7y- .�,�
INSPAfOVE
POOL
,�.�"GC%� V t!
O
NUISIIER OF STORIES
NUSiIIER OF
L
DWELLING
UNITS
`
Valuation Fee Receipt No.
NATURE OF WORK TO DE DONE
U r 4tA/A: (,J,+,, C�uffAUC
Plan Check NO .....................
v� 1IF6
r.
�1Oa
BUILDING
S OGO
r3
4 PROPOSED B
aPLUMBING
Re-i.>•/� SAS
A C- lei y II
P s2aZtL
es
HEAT & GAB LINE
.f—
j
PLOT PLAN (Indicate Building setbacks, abutting streets)
C
FENCE
i
SIGN
t
RETAINING WALL
I
I
SWIMMING POOL
I
DEMOLITION
PRE -MOVE INSPECTION
1
EXCAVATION OR FILL
TOTAL AMOUNT DUE
2
jD 80 q/0
1 hereby acknoWledgo that I beve reed this application: that the In-
t '
formation given le correct: and that I am the owner, or the duly author-
Ized agent of tho owner. 1 agree to comply with clly and state taws regu-
ATTENTION
APPLICATION APPROVAL
lating co. Metlon: and In doing the work autharlxed thereby, no Person
Will be employed In violation of the Labor Code of the Slate of Washington
TIUB PERMIT
This application is not a permit until
relating to Workmen's Compensation Iruurance,
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS Which
ONLY THE
WORE NOTED
fees are paid, and receipt is ac -
.hall be comPlcted In ninety days: MOVEIII-1N 13ULLDINOS Shall be corn.
in space provided,
pitted In six months.)
81ONATUItE (OWN fl O AGENT) DATE SIGNED
INSPECTION
BI URH
�_�'CITYOF'IYA
DEPARTMENT
gknovOelged
NOTE: Applicant Subject to Plan Check Fee
EDMONDS
775-2525
11
This Penult co— work to be done Private property y ONLY.
coast (e
Any <nnst rueRnn on Ib public domain ...iden'ulks, drit nn'aye,
FILE
rli.l „III rr,nurc .rl�nralr lirr,nl.nlnn. �
I'a
_