750077.pdf1
BUILDING DEPARTMENT USE
NUMBER 7500-77
Appucnnt FW
PERMIT APPLICATION
inside Heavy Lines JOB
ADDRESS 3 ge� 76
NAME (OA NAME ON BUSINESS) WWW `
PERMISSIBLE ACTUAL J
LOT COVERAOF. G LOT COVERAGE
MAILING ADDRESS J l p
PEIifil ltldlHLE HEIGHT / PROPOSED HEl 7
T N Wit/ ACI`UAL LOT EA TOTAL L A A f
CITY TELEPHONE NUMBER D !
`U'z -;t' RE 1 YARDS PROPOSED YARD a.
NAME FRONT d[DE REAR FRONT BIDE REAR
I ANS i
ADDREdB L 6AL LO'r Ali CE OR CONDITIONAL UBE
®' YES NO PERMIT NUMBER
PI ANN I O D YIiOVA D TE'
F CITY
x
CITY
J li
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TELEPHONE NUMBER
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STREET RIW
EXISTING STREET R/W ............FT,
DEFICIENCY THIS PROPERTY
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NAMEI
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COMP. PLAN ST. R/W ............FT.
............FT.
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REMARKS
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Cd ADDRESS
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Legal Description of Property (Show Below Cr Attach Four Copies)
FIEF 'H I T-ActmI
CRECKED H
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I TELEPHONE NUMBER
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METER SIZE SERVICE SIZE CLEARANCE
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
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REMARKS
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FIEF 'H I T-ActmI
TYPE CONNECTION
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PERC. TEST
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REMARKS
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Film ZONE I TYPE OFSTRUCTIgN eTHEE•r I IPFRNO D
SPECIAL INSPECTOR REQUIRED
GROOPC/
OOGROUP
RESIDENTIAL
GA8
E]LINE
❑ YES [�Tf
❑ NEW
PLAN CHECK DII
THIS SITE IS LOCATED IN THE CITY
❑ NON-RESIDENTIAL
❑
OF AL SALES TAX
BION
.t.z�--
ULD 6E CODED
® ADD RETAINING
❑ WALL
❑
R' A 9
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DEMOLISH
❑ ALTER EXCAVATE FENCE
• %// Didri,�dGiid/J
O']
/�ct%ii6cs i9,��3
❑ REPAIR ❑ PRE-"❑ swim
INdP. POOL
/� ��/ s//�
NUA1SEn OF BTOIiIEd NUMBER OF
l
DWELLING
UNITS 0 Q
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NATURE OF WORK TO HE DONE
Vnluatien
Fee Rectlnt No.
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CQl hJS -V 11 E i` k_ V-, .HC`{'. til C -'A A LZ.�
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Pian Check No .....................
BUILDING
�y
F:
W PROPOSED USE
PLUMBING
O
O PLOT PLAN (I Icnte Building setback., abutting street.)
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HEAT & GAS LINE
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,t�
J/
FENCE
SIGN
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RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
[ hereby neknowlCdge that I have rend this nppllcatlon; that the In.
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formation am the le correct; and that I athe owner, or the duly aulhor-
Ized .gent of In, owner. I agree to Comply with City and state laws resu-
ATTENTION
APPLICATION APPROVAL
lacing c...truetion; and In doing the work authorized thereby, no person
'
will be employed In Violation of the Labor Code of the State of Washington
TIDE PERMIT
This application is not a hermit
Until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official
or his Dep.
.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
uty; and fees are paid, and repeipt
is ac -
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
WORK NOTED
ledged in space provided.)
pleted In .IX month..)
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SIGNATURE (OWNER OR AGENT) I DATE SIGNED
INSPECTION
PI R' ofgNA RE
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DEPARTMENT
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J�w�, :.�.� . ,v C f� q L L., S..
CITY OF
NOTE: Applicant Subject to Plats CGeck Fee
EDAZONDS
ATE
775-2525
Thle Permit Property ONLY.
ction work to be dans
Any cen•trarquees. the(c bs, sidateewalks,
ruc Publicd
drlvewsys,
domain (curbs,permission.
marquees. tl C.) .r1il regWre eenarate Permleelon.
FILE
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is it
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'alowe 11.6m FOR 614-c'p,
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BUILDING DEPARTMENT Applicant Fla USE PERMIT
ZONE - �r NUMBER
is
PERMIT APPLICATION I Inside Heavy Lined
NAME (OR NAME OF BUSINESS)
MAILING ADDRESS
C ( 1-
CITY TELEPHONE NUMBER
NAME
• I'll Int-
-c:l -t- •y.�
ADnxEtlB
JOB
ADDRESS
%
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PERMISSIBLE ^'
ACTUAL v/�
LOT COVERAGIP _ LOT _iLOT
COVEIIAGE (COVEIIAOE (�
PERAlIS8IBLE HEIGHT
J�
PROPOSED HEIOyy y{py''`^
A /1 F'-\
ACTVAL LOTt /�R;A
TOTAL $LDOD
�`-'-
aA
Ul D YAItOd
PROPOSED YARDS
FRONT' dIUE BE
FRONT SIDE REAR
1 i
STREET R/W
EXISTING STREET R/W ............F•r.
LEGAL LOT `"VARIANCE OR CONDITIONAL UBE
ff YES NO PERMIT NUMBER
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'Yt -1 C" I � `u i•Ir-)V1 F\ T'\ tlE Ij
PLANNING DEPT. ]'ROYAL
.� DATE:
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CITY
TELEYHONE NUAIBEit
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STREET R/W
EXISTING STREET R/W ............F•r.
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DEFICIENCY THI8 PROPERTY
I
NAME
^ q
COMP. PLAN eT. R/W ............FT.
............FT.
REMARKS
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Ol
ADDISEdd
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CHECKED BY /)
CITY
TELEPHONE NUMBER.
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,
T
METER SIZE
SERVICE SIZE
CLEARANCE
HECHED' yy
STATE LICENSE NUMBER
CITY LICENSE NUMEEK
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REMARKS
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Legal Description of Property (Show Below or Attach Four Copies)
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\F F %i I fA(-o G_tl
TYPE CONNECTION
VERIFIED BY
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P11! T
PER NUM C
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FIRE ZONE TYPE OF CONS TR CTIO T IMPROVED
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%...- I �- f✓ YE o No
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SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
�l RESIDENTIAL
GAB
❑ YES Eg-No
I
NEW
LINE
PLAN CHECI{F.D BY
THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
l''l;//,... �T p/
OF EDMONDS. LOCAL SALES TAX
SIGN
.`.4.? c l-••^--
-� SHOULD 8E CODED 31.04.
ADD
❑O RETAINING
WALL
RBMA B
DEMOLISH
FENCE
ALTER EXCAVATE
❑ OR FILL (.........x _.....-.Ft.7
❑ PRE -MOVE SWIM
REPAIR
� � POOL
/ _ - 7""
i.
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS [)�
NATURE OF WORK TO BE DONE
Valuation
Fee
11-rlpt No.
5
1'Inn Check No .....................
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BUILDING
,
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`� ���
-
— __
PROPOSED UBE
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✓.
a
PLUM8IN6
G
APLOT
_
PLAN (I laicato II ng�B tbn�ks� o oiling streets)
HEAT &GAB LINE
. _... _._. _.._.._.____.._�.
FENCE
—
-
SIGN
—_
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
—
EXCAVATION OR FILL
-
TOTAL AMOUNT DUE
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I hereby acknowledsa that 1 h¢ve rend this application; that the 1n-
✓. / ---
formation given le correct; and that I ara the owner, or the duly author-
Izsd agent of the owner. I agree to comply with city and state law. regu-
ATTENTION
APPLICATION APPROVAL
lat(ng Was ruction; and 1n doing the work authorized thereby, no person
Will he employed In vlolntioa or the Labor Code of the Slate of Washington
THIS I-ER511T
This application Is not a permit until
,statics to Workmen's Compensation Insurance.
AUTHORIZER
elgned by the Building Official or his Dap -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TIE
WORK NOTED
Uty; and fees are paid, and receipt Is ac.
.ball be completed In ninety day.; MOVED -IN BUILDINGS Shall bcont-
e
knoWledged In space provided.
plated In six months.)
INSPECTION
-i
)
i
SIGNATURE (OWNER OR AGENT) DATE SIGNED
D1R It'tl tlIONATUitE +%
DEPARTMENT
. .... .._.
- a-. a._S.'•..' I-. D k t ,C .) !, - l
CITY OF
EDMONDS
Arl•. j ''�
NOTE: Applicant Subject to Plan Check Fee
).}_....
775-2525
This PernAt covers work to ho done on private property ONLY.
Any construction on ilia public domain (curbs. sidewalks, driren'ay.,
m¢rqueee, e1c.) Mill require separate permission.
INSPECTOR
-?5007
RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial) ---
(Rough)
Frame
Furnace &Fuel Lines
Final y�
M
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