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STREET R/1Y
EXIeTiNG STREET R/W ............FT. DEFICIENCY THIS PROPERTY
EXISTING
COMP. PLAN ST. R/W ............FT. ............FT,
RESIDENTIAL
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ICHECKED BY
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SIGN
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ADD
USE PERMIT
NUMBER
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ACTUAL LOT AREA TOTAL BLDG. AREA 8,33 �
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APPLICATION APPROVAL -
CITY
E NUMBER
This application is not A permit Until
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AUTHORIZES
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STREET R/1Y
EXIeTiNG STREET R/W ............FT. DEFICIENCY THIS PROPERTY
EXISTING
COMP. PLAN ST. R/W ............FT. ............FT,
RESIDENTIAL
P
ICHECKED BY
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NEWEl
❑
NON-RESIDENTIAL
❑
SIGN
REMARKS /
ADD
PLUMBING
DEPARTMENT
U
ZPLOT PLAN (Indicate Building setback., abutting streets)
RETAININGA
HEAT & GAS LINE
5
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❑
DEMOLISH
❑
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Fee
ALTER
RETAINING WALL
❑
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Any construction on lite public domain (curb., sidewalks, driveway.,
REPAIR
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UNITSER
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EXIeTiNG STREET R/W ............FT. DEFICIENCY THIS PROPERTY
EXISTING
COMP. PLAN ST. R/W ............FT. ............FT,
REMARKS
P
ICHECKED BY
METER 812E
I SERVICE SIZE CLEARANCE
( CHECKED BY
REMARKS
TYPE CONNECTION VERIFIED BY
PERC. TEST I PERMIT NUMBER
REMARKS /
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TYPE OF CONSTRUCTION STREET IMPROVED
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SPECIAL INSPECTOR REQUIRED
YE B NO
OCCUPANCY O OUP
PLANCICxI:q 13Y THIS SITE IS LOCATED IN THE CITY
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SHOULD sE CODED 31.04.
REMARKS
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Valuation
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BUILDING
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HEAT & GAS LINE
5
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PENCE
SIGN
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Fee
MONS
EDbIONDS
RETAINING WALL
NOTE: Applicant Subject to Plan Check
7
N
SWIMMING POOL
DEMOLITION
Any construction on lite public domain (curb., sidewalks, driveway.,
PRE -MOVE INSPECTION
FILE
niarpuees, etc.) will relic re separate permission.
EXCAVATION OR FILL
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TOTAL AMOUNT DUE
I heteby acknowledge that I have road this application; that the In.
forma tion given le correct; and that I am the owes,, or the duly author-
Ized agent of the owner. I agree to comply with city and elate law. rag.•
and
laung construction; and In doing the work authorized thereby, no per..
ATTENTION
APPLICATION APPROVAL -
will be employed to of Ne Labor Code of the Stale of W¢.htpgion
THIS PERMIT
This application is not A permit Until
relatt.g to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall he completed to ninety day.; MOVED -IN BUILDINGS shall be coal•
AUTHORIZES
ONLY THE
WORK NOTED
signed by the Building Official or his Dep -
Uty; and fees are paid, and receipt Is ac.
knowledged in space provided.
pleted In six months.)
SIGNA IIHr,iT0YNER OR AGENT)
DATE SIGNED
INSPECTION
DIRECTOR' SIGNA' R i,
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DEPARTMENT
CITY OF
a
Fee
MONS
EDbIONDS
DATE
NOTE: Applicant Subject to Plan Check
7
This Permit rovers work to be done on private property ONLY.
Any construction on lite public domain (curb., sidewalks, driveway.,
FILE
niarpuees, etc.) will relic re separate permission.
7.
BUILDING DEPARTMENT ° NO...I"", 7500�
AppLcant Flll �– 1
PERMIT APPLICATION Inside Heavy Lines -To-13
ADDRESS
NAME (OR NAME OF BUSINESS)
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LOTCVERAJLOT COVERAGE � LOT COVEAOE
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TELEPHONE NUMBERACTUAL
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LOT AR A { TOTAL BLDG. AREAx�Fzvl4
9�EAR
REQUIf ED YARD9PROPOBEUNAME) FRONT SIDE REAR FRONT BIDE
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ADDRESS
F
LEVY I.OT VARIAN CL GOND T10NAL
4 YES � NO PERMIT NUMBER
PLANNING DEP T A Y VAL DATE:
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lG CITY
TELEPHONE NUMBER
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EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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COMP. PLAN BT. R/W ............FT. ............FT.
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TELEPHONE NUMBER,S��J�R-'
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METER SIZE
BERVICE SIZE CLEARANCE
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CHECKED HY
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V STATE LICENSE NUMBER
CITY LICENSE NUMBER
REMARKd
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EXCAVATION OR FILL
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Legal Description of Property (Show Below or Attach Four Copies)
A�a p/
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TYPE pO1 ECTION
VERIFIED BY
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APPLICATION APPROVALoa: •
lating con.tructland In doing the work authorized thereby, no person
Id 1
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-FE—Itti. U ST ( I _ )
PERMIT NUMBER
Title PERMIT
W
REMARKS -_. .L-
FIRE ZONE TYPE OF CONSTRUCTIONBTIC' OVED
YE9 1] NO
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
'
i i
.
SPECIAL INSPECTOR REQUIRED
O YES NO
IOCCUPASVC� UP
GAS
REd[DENTIAL F-1C.A.".PLAN
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NINC
ADD RETAI❑ DEMOLISH ❑ WALL
FENCE
El ALTER ❑ C
ORFILL E (.....................Pt.)
CH CISE BYTHIS SITE IS LOCATED IN THE CITY
( OF EDMONDS. LOCAL SALES TAX
" SHOULD BE CODED 31.04.
REMARKS /n� � J /7 �% �'7 'ter
LV GyO /�! �L t /� UI&C / ( /moi
SIONATUUE,-(OWNER Olt AGENT) DATE elONEU
'/;
REPAIR ❑ INSPhfOVE
❑ POOL
/•? ,4
DEPARTMENT
NUMBER OF STORIES NUhfIIER OF
/ I UN TBLING " )p . ) L
CITY OF
Plan Check N/
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3-2 Oe)
BUILDING
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PROPOSED USE
I
PLUMBING
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PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT R OAS LINE
FENCE
SIGN
I
RETAINING WALL
N
SWIMMING POOL
1
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In -
,.,motion given I.correct; and that I the. the owner, or the duly author.
j
Ized agent of the owner. I agree to comply with city and state law. regu.
ATTENTION
APPLICATION APPROVALoa: •
lating con.tructland In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
Title PERMIT
This application is not a permit until
relating to Workmen'. Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac- `
shall be completed In ninety day.; MOVED -IN BUILDINGS .hall be cam•
knowledged in space provided.
pleted In six months.)
SIONATUUE,-(OWNER Olt AGENT) DATE elONEU
'/;
INSPECTION
DIRECTOR'S SIGNA BRE
/•? ,4
DEPARTMENT
� }-•,
CITY OF
EDMONDS
DATE .�.
NOTE: Applicant Subject to Plan Cbeck Pee
!
~ 7 S
7752525
/
This Permit covers work to be done on private property ONLY.
Any construction on the publle domain (curbs, sidewalks, driveways,
INSPECTOR
margneea, etc.) will require separate permieslon.
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