740598.pdfPERMIT
BUILDING DEPARTMENT Applicant Fin ZOO S- NUMBEP
ADDRESS
PERAIItlSIBLE � 35�a
LOT COVF.RAOE
PERMISSIBLE HEIGHT I
'30 r
ACTUAL LOT AREg N/ 7
R/QUIIRREEDID YARDS
FRONT SIDE REAR
Lost �5
I: ES LOT VAR AIT CE M
YES Q NO PERMIT NUMB]
tl ! PLANA E. �AP)PRO
t!� CITY _^^ 1 ( , / T/E�LEP�H(�ONE NU'MBER � 1 r!
•C y ma;v [3 S I /1V I ! P V J/ 00 L EXISTING
STREET R/VP'.n. .a,
NAME ll
A) COMP. PLAN ST. R/KC,`_om
C ADDREBB J-•_ , /' REM"RKB Drimay slopes i
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PERMIT APPLICATION
F CITY
Inside Heavy Linos
PLAN CR cK BY
NAME (OR NAME OF BUSINESS)
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NFFMA1W�11N0
O
,A1•DDREES
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METER 81'LE SERVIC
CITY
TELEPHONE NUMBER -
a a.s a I / _) J 7
NAME.
�AM i �_ T; /I,- JO;VAI J0,e
E
ADDRESS
RE RKS
TYPE CONNECTION
ADDRESS
PERAIItlSIBLE � 35�a
LOT COVF.RAOE
PERMISSIBLE HEIGHT I
'30 r
ACTUAL LOT AREg N/ 7
R/QUIIRREEDID YARDS
FRONT SIDE REAR
Lost �5
I: ES LOT VAR AIT CE M
YES Q NO PERMIT NUMB]
tl ! PLANA E. �AP)PRO
t!� CITY _^^ 1 ( , / T/E�LEP�H(�ONE NU'MBER � 1 r!
•C y ma;v [3 S I /1V I ! P V J/ 00 L EXISTING
STREET R/VP'.n. .a,
NAME ll
A) COMP. PLAN ST. R/KC,`_om
C ADDREBB J-•_ , /' REM"RKB Drimay slopes i
!v
indicated on Stai
F CITY
TELEPHONENUMBER
PLAN CR cK BY
!✓Arn�n/dJ 1✓Yi��
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ntIND C
U
(/
METER 81'LE SERVIC
STATE LICENSE NUMBER
CITY LICENSE NUMBER
a a.s a I / _) J 7
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/8'J, �J 61"-
�i/ �S/ N(/G%zd-) A l— (3 /7 % 7
❑ ORFILLEXCAVATE ❑
Legal -Denarlptlon of Property (Show Below or Attach Four Coplee)
RE RKS
TYPE CONNECTION
i
INSP. F1 POOL
�Uf3 .IZ��j-' TZI
PERC. TEST
NUNHER Ol•' STORIES NUMBER OF
W
O
a
REMARKS
FIRE ZONE , TVPF• nc
V
W
.i
[3 NO
RESIDENTIAL LINE
❑ YES
PLAN CR cK BY
THIS SITE IS LOCATED IN THE CITY
,® NEW
ELI NON-RESIDENTIAL ❑ SIGN
❑
Of EDMONDS. LOCAL SALES TAX
HOULD BE CODED 31.04.
ADD
0 DEMOLISH ❑ RETAINING
EMA
ALTER FENQu..........F[.)
/ p n r-•�
/8'J, �J 61"-
�i/ �S/ N(/G%zd-) A l— (3 /7 % 7
❑ ORFILLEXCAVATE ❑
REPAIR PRE-MOVE-
INSP. F1 POOL
�Uf3 .IZ��j-' TZI
C/N/!h �/y .�i�(%!✓l
NUNHER Ol•' STORIES NUMBER OF
I DWELLING
I
UNITS
NATURE OF WORK TO HE DONE
Valuation
Fee Receipt N,
Plan Check No .....................
i
0
BUILDING
pO
43
PROPOSED UBE
U
PLUMBING
PLOT PLAN (Indlcate Building setback., abutting streets)
HEAT & GAB LINE
Q J�
PENCE
SIGN
r //
�7 `• ! 1 ��-A
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE. INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this
s application; that the In.
AMOUNT DUE
6ei
/'
formation given Is correct; and that I am the owner, or the duly author-
the owner. I agree to eawith city and elate laws ergo-
fud agent tr work
Iating eons[rutlloa; and In doing the work authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
will be employed In vlolntlon of the Labor Code of the Slate of Washington
relating to Workmen's Compensation
THUS PERMIT
This application is not a permik until
Iasuresnu.
NOTE: Permit Limit One Year
AUTHORIZES
ONLY THE
signed by the Building Official or his Dep -
(Except DEMOLITIONS which
be
WORK NOTED
Uty; and Pees are paid, and receipt is 6C-
ehnil completca In ninety deya; MOVED -IN BUILDINGS amu be was-
knowledged in
pleted In nix monlhn.)
space provided.
SIGNATUIt ((_O,WNEpR�OR AOENT) DIATE .0
.� L, 1•vi.s+.y— �) ��.� IO
INSPECTION
DEPARTMENT
O 'S 10 TURF /
CITY OF
EDMOND3
ATE
NOTE: Applicant Subject to Plan Check Fee
/ice A
This Permit .oven work to be done an prlvoy ONLY.
775-2525
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Any rnnntrnrlien nn ibr pubilc domain (rnrU., sldrn'nikn, drlrmt'ayn,
Id Ik,,
,ril��c„. rtc.l alit r.lul r.• .,•parol.• Irru,l�.lrn.
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