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BUILDING DEPARTMENT AppllcantFW ZONE NUMBERM %Lifl�i77
PERMIT APPLICATION I Inside Heavy Lines
NAME OR N E OF
MATI.I O DDRE88
TELEPHONE N MBEIt
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Pr:Ilhtl881BLII %
IAT COVERAOF.
A A
LOT COVESYAtlE
PERMISSIBLE HEIGHT
PROPOSED HEIGHT
ACTUAL LOT AREA
TOTAL HLUG. AREA
REQUIRED YARDS
FI20NT HIDE REAR
YROPOHFt) YARDS
FRONT BIDE REAR
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CITY
I.EOA1. LOTAj1 ANCE OR CONDITIONAL USE
PENMIT NUMBER
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ADDRESS
❑ YF. ❑
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PLANNING DEPT. APPROVAL
DATE:
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CITY
TELEPHONE NUMBER
R/W
EXISTING STREET R/W ............FI'.
EXISTING
DEFICIENCY THIS PROPERTY
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NAME
COMP. PLAN BT. R/W ............FT.
............FT.
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REMARKS
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CHECKED BY
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TELEPHONE NUMBER
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METER 81ZE SERVICE SIZE
CLEARANCE
CHECKED BY
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TA LICENSE NUMBER
CITY LICENSE NUMBER
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REMARKB
Legal Description of Properly (Show Below or Attach Four Copies)
TYPE CONNECTION
VERIFIED BY
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PERC. TEST
PERMIT NUMBER
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REMARKS
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FIRE ZONE I TYPE OF CONSTRUCTION STREET IMPROVED
❑ YES ❑ NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
RESIDENTIAL
GA0
� LINE
❑ YES ❑ NO
THIS SITE IS LOCATED IN THE CITY
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PLAN CHECKED BY
NEW
NON-RESIDENTIAL1
11 SIGN
OF EDMONDS. LOCAL SALES TAX
BE CODED 3104.
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ADD ❑ RETAINING
El DEMOLISH WALL
REMARKS
SHOULD
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ALTER ❑ ORCFILL AVATE ❑ PEN C x..........Ft.)
'
REPAIR ❑ PRE -NSP. ElPOOL1
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NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Valuation
Fee Receipt No.
Plan Check No . .. ..................
BUILDING
],
PROP08ED UBE
a
PLUMBING
U
aPLOT
PLAN (Indleats Hulldmg sclbneke, flbutting alreeta)
HEAT A GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
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PRE -MOVE INSPECTION
EXCAVATION OR FILL'S
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this appl)catlon; that the In-
formation given Is correct; and that I um the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and elate laws Mgu-
ATTENTION
APPLICATION APPROVAL
luting construction; and In doing the work authorized thereby, no person
will be employed to violation of the Labor Code of the State of Weehington
THIS PERMIT
This application is not a permit until
relating to Workman'. Compensation Ie cce.bee.
AUTHORIZES
signed by the Building Official or his Dep -
N E: P rtei Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
Uty: and fees are paid, and receipt is ac -
abut be co pleted In ninety days; MOVED -IN BUILDINGS shall be coin-
knowledged in space provided.
plc d In a mon s.)
910 ATUI (Oi EA OR AGENT) DAT S16NE
INSPECTION
Dl OR'B.H BIONAT RE �•_µ,�
DEPARTMENT
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CITY OF
EDMONDB
DATE
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NOTE: Applicant Subject to Plan Cbrck Fl,
775-2525
Thi. Permit coven work to be dean un private property ONLY.
i
Any eonelructlun on the public domain (curbs, .Idew.lk., driveways,
FILEmarquee.,
fir.) will require .eparate perml..lon.
-
USE
BUILDING DEPARTMENT AppliPmtFill 'ONE NU BIER -7A',r-7 7
FRONT BIDE
REAR FRONT BIDE REAR
Inside Heavy Lines ADDRESS
PERMIT APPLICATION
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NAME (OR NAME OF BUSINESS)
PERMIeBiBLE m ACTUAL J
�' IAT COVERAGES LOT COVEIiAOEt
1
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MAt1.ING ADDRESS PERMISSIBLE HEIGHT PROPOSED HFIOHT O
[] YES 13 NO PERMIT
PLANNING DEPT. API•ROVAL
NUMBER
DATE:
O C1TY(•. / ` � TELEPHONE NUMBER ACTUAL LOT AREA TOTAL BLDG. AREA 7
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(r (• ....�'++-�./N. REQUIRED YARDS PROPOSED YARDS
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NAME c
FRONT BIDE
REAR FRONT BIDE REAR
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LEGAL LOT VARIANCE OR CONDITIONAL USE
!
ADDRESS
[] YES 13 NO PERMIT
PLANNING DEPT. API•ROVAL
NUMBER
DATE:
C
G
CITY ITELEPHONE NUMBER
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
07
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NAME `
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ADDI ESS --
COMP. PLAN ST. R/W ............F-1'.
REMARKS
............FT.
CHECKED BY
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CITY- TELEPHONE NUMBER
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METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
tC
STAT�)LICENSW NUMBER
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CITY LICENSE NUMBER
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REMARKS
Legal Description of Property (Show Below or Attach Four Copies) ,
TYPE CONNECTION
VERIFIED BY
nn
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PERC T PERMIT NUMBER
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RNMAIIKS/ '/,
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FIRE ZONE TYPE OF CONSTRUCTIO
1 'I / I STRPE 1 R VED
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YE
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
GASRESIDENTIAL F-1LIN YES (] NO
LINE PLAN cxflcxED BY THIS SITE IS LOCATED IN THE CITY
❑ NEN
❑ NON-RESIDENTIAL ❑SIGN OF EDMONDS. LOCAL SALES TAX
❑ ADD RETAINING REMARKS SHOULD BE CODED 31.04.
❑ DEMOLISH ❑ WALL
❑ ALTER ❑ EXCAVATE [:] FENOR FIILLCx..........Fl.)
❑ REPAIR ❑ PN PTSOVE El SWI I
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
No,
NATURE OF WORK TO BE DONE
Valuation
Fee
ReeelPL
Plan Check No .....................
BUILDING
tr
a,
PROPOSED USE
PLUMBING
O
�% (J Q
PLOT PLAN (InUlcola IIul\Ing.@c(.O�npk(,fnb tting Streets)
C 1iJ\
HEAT A, GAS LINE
o
PENCE
SIGN
TRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that 1 have recd title application; that the In-
C)
[.'motion given le correct; and that I am the owner, or the duly author.
Iced agent of the owner, I agree to comply with city and state law. regu-
lating construction; and In doing the work authorised thereby, no person
ATTENTION
APPLICATION APPROVAL
will be employed In violation of the Labor Code of the Stale of, woehington
THIR PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance,
NOTE: Permit limit One Year (Except DEMOLITIONS whl.l,
shall be completed In ninety days; MOVED -IN BUILDINGS Shall be win.
pleled In six months.)
AUTHORIZES
ONLY THE
WORK NOTED
Signed by the Building Official Or his Dep
Utyi and fees are paid, and receipt is
knowledged in space provided,
1* �Ip'
-
so
_
SIO ATURt (OWNER OIL AGENT) DATE SIONEU
..
NOTE: Applicant Subject to Plan Check Fie
INSPECTION
DEPARTMENT
CITY OF
ED51ONDS
775.2525
TOS
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�r ���:'+✓ �;%(,�-
�.. e,Gcc�IiT, L•
DATE
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Thls Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marq..... .ir.) will require .,parole perml..I-.
INSPECTOR