740601.pdfA
BUILDING DEPARTMENT
ZONE PERMIT740601
Applicant Fill
PERMIT APPLICATION I
Inside Heavy Lines
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ADDRESS
NAME (OR NAME OF HU8lNEBB)
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PEItMIeSIACTUAL
LOT COVERAGEHLE LOT COV LGE
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M IL% ADDRESS
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PERMISSIBLE
PERMISSIBLE HEIGHT PROPOSED HEIGHT
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(5 -1 -Ty
TELEPHONE NUMBER
ACTUAL LOT AREA TOTAL BLDO.AREA
x
NAME
REQUIRED YARDS PROPOSED YARDS
FRONT BIDE REAR FRONT BIDE REAR
F
ADDRESS
LEGAL 0 YES L�0 NO PERMIT NUMBER VARIA OR NDITIONAL USE
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C1TYTELEPHONE
NUMBER
PLANNING DEPT. APPROVAL DATE:
STREET R/lV
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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NAME C,C n)
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COMP. PLAN ST. R/W ............FT. ............FT.
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ADDRESS
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CHECXED BY
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TEL EPHONE NUMB
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STATE LICENSE NUaIBEIi
CITY LICENSE NUMBER
MISTER BI2E SERVICE BIZE
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CLEARANCE
CH CKED BY
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Legal Description or Property (Show Below or Attach Four Copies)
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TYPE CONNECTION VERIFIED
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YEIiC. TESTI PERMIT UMBER
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REMARKS
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F1RE ZOLtE TYPE OF CONSTRUCTION STREET IMPROVED
Its
L{� YES NO
SPECIAL INSPECTOR REQUIRED I OCCUPANCY GROUP
RESIDENTIAL ❑ LINE
❑ NEW
_F YEB ❑ NO
PLAN CHECXED IIY
THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL eta.
ADD
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED Rind
RETAINING
DEMOLISH WALL
REMARKS
El ALTER ❑ EXCFILLAVATE E PENCE
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REPAIR ❑
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NUMBER F STORIESl
NUMBER OF
/ DWELLING
UNITS
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NATURE OF 0 K TO BE DONE
V¢luallon
Fee Receipt Na.
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Plan Check N
BUILDING
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aPROPOSED
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PLUMBING
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PLOT PLAN (Inalcnte Bullaing
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setback., abutting street.)
HEAT & GAS LANE
FENCE
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SIGN
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RETAINING WALL
,
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby scknawledge that I have read this app ilcntlor.; that the In-
rorm¢tlan
given Ie correct; and that I am the owner, or th. duly author-
Irea agent or the owner. I agree to Comply with City and stale lows reg.-
conetructlon; and 1. doing the work authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
'viiiing
In lall.. -1 the Labor Code the State or Wmhfngton
THIS PERMIT
rel¢tinge toplWorkmen'eeyed
ComDensatlon Imurance?t
AUTIKOFUZES
This application is not a permit until
NOTE: Permit Limit One Year (Except
ONLY TILE
signed by the Building Official or his Dep-
which
Shall bI completed In ninety days; MOVED -IN BBILDIN03 shall be com•
BUILDINGS
WORK NOTED
uty: and fees are paid, and receipt Is ac-
plclyd In six months.)
Imowled gad In apace provided.
SIGNATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
1 / y�`Hr
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DEPARTMENT
RE O 'S ION URE
CITY OF
NOTE: Applicant Subject to Plan Check Fee
EDMONDS
775-2525
DTE
d
Thi. Permit CaNers work to be done on private property ONLY.
Any construction on the public do..ln (curbs, sidewalks, driveway.,
mm'queerse
., Or.) .ill require parate permleslnn•
FILE
71
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7�/pLeOJ.:.
RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
( Rough)
Frame
Furnace & Fuel Lines
Final :.r
i
�— DEPARTMENT
ZONE
NUMBER
BUILDING Applicant Fill
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PERMIT APPLICATIONI Inside Heavy tmeg
JOBDRESS
,
NAME (OR NAME OF DUS1NE08)
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PERMLOTC
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LOT COVERAGE
VERA
LOT CO
LOT COVERAGE
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MAILING A13DIIESBC
PE(tAiltldlBLE HEIGHT
PROPOSED HEIGHT
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CIT Y
TELEPHONE NUMBER
ACTUAL LOT AREA
TOTAL BLDG. AREA
[
17_7(�5 `3
REQUIRED YARDS PROPOBRD YARDS
-.'S:
FRONT °IDE
REAR FRONT BIDE REAR
,
NAME'
FLEGALL
ADDRESS
i
LOT
VAR ANCE OR CONDITIONAL USE
PERMIT NUMBER
_ - '--_�
Q YES 0 NO
PLANNING DEPT. APPROVAL DATE:
-
CITY
TELEPHONE NUMBER
'/
'
STREET R/W
EXISTING STREET R/W ............F7'. DEFICIENCY THIS PROPERTY
C
NAME
COMP. PLAN 8T. R/W ............FT. ............FT.
W
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r�i_(a5 T
REASARICB
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ADDRESS f
x
I�
•
CHECKED HY
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CC
CITY
TELEPHONE NUMBER
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_%
✓ 41 Z
81LE SERVICE SIZE CLEARANCE
CHECKED BY
?7CA'7•i ./t:J
/
METER
STATE LICENSE NUA7 E//RCITY
LICENSE NUMBER
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REMARKS
Legal Description of Property (Show Below or Attach Fear Copies)
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TYPE CONNECTION
BY
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O
(VERIFIED
ly
PERC. TEST
PERMIT NUMBER
C
Ip
REMARICS
W
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FIRE ZONE TYPE OF CONSTRUCTIONSTREET IMPROVED
_ . I
'' r'YES 0 NO
VOCCUPANCY
SPECIAL INSPECTOR REQUIRED
GROUP
�-RESIDENTIAL
❑ GAS
❑YES CFyNO
I
NEW
LINE
PLAN.CHECKED BY
THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
NON -R
SIGN
!'L__...-._____.___.
01' EDMONDS. LOCAL SALES TAX
ADD
REMARKS
DED
SHOULD IiE CO31.04.
❑RETAINING
DEAtOLISH WALL
^
ALTER EXCAVATE ❑ FENCE
_
:.: !J_• /i .
.";'-_ �; r �'+'✓t'-� % _�,a-: �/6�� .-
❑ OR FILL (.......... x .......... Fl.)
INBP. swlhl
PRE -MOVE POOL
'REPAIR E]El POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE/ DONE
Valuation
Fee Reeelpt No.
a r L c .:awLl / G.�i---. t •f •t_:• c Ls_c_Jf-i
b--...+�
Pion Check No .....................
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''1'�' (� '../l%-. i .Lr-_ .-2i)
BUILDING
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[O
4
PROPOSED USE
PLUMBING
-
a
PLOT PLAN (Indlcnto Building setback., abutting atresia)
HEAT &GAS LINE
7
FENCE
(((
SIGN
RETAINING 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 Is correct; and that I o a the owner, or the duly author-
Ixed agent of the owner. I agree to comply with city and elate Iowa regu-
ATTENTION
APPLICATION APPROVAL
luting conetructloa; and In doing the work authorized thereby, no person
Will be, employed In violation or the Labor Code of the Slate of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official Or his Dep -
NOTE: Permit Limit One Year (EXCept DEMOLITIONS whlcb
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is so.
shall be completed In ninety days: MOVED -IN BUILDINGS shall be com.
knowledged in space provided.
pleted In six months.)
_.-.
SIGNATURE (OIYNER OR AGENT)
DATE SIGNED
INSPECTION
DIRECTOR'° SIGNATURE'S P
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DEPARTMENT
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CITY OF',I
EDMONDS
DTE
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NOTE: Applicant to Plan Chcck Fee
hhcant Subject
775-2525
This Permit covers ,.,it to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalk., driveway.,
INSPECTOR
marquees, etc.) will repulre separate permiedon.