750096.pdf,
BUILDING DEPARTMENT
USEJ
ZONE
PERMIT
NUMBER 750096
a,
AppUPant Fill
PERMIT APPLICATION
Inside Heavy Lines
JOB I
ADDRESS 3 j) 6 /-/ /t /4) 5 �%
1
NAME (OR NAME OF BUSINESS)
c�
/ _ /'+ /
C
I
^� /�
Q I N i E rz 1 h IT N K_
PERMISSIBLE '7
IAT COVERAGE
ACTUAL
LOT COVAAGE
t
C
.�,& ADDRE08
�3
'
FPERMISSIBLE
HEIGHT
PROPOSED HEIGHT
e
�d L/7 ill ,t\1P
CITY
TELEPHONE NUMBER
ACTUAL LOT AREA
TOTAL BLDG. AREA
;I
•t
p lM O 1
REQUIRED YARDS
PROPOSED YARDS
1'1j
NAME
FRON'17
REAR FRONT 61DE REAR
I
ji
LEGAL LOT VARIANOR CONDITIONAL U E
H
ADDRESS
0 YES I] NO PERMIT
NCE
UMBER TI-�'Y✓l lQ7
j I
7
J
I�
PLANNING DEPT. APPROVAL DATE:
CITY
TELEPHONE NUMBER
I
STREETR/W
EXISTING STREET A/
:..PT. DEFICIENCY THIS PROPERTY
x
NAME
COMP. PLAN ST. R/ ...
.Z.) FT.
to
��
T U — R 2T \ ) I S 1� L lA k .Q
REhfARKB
z
I
AD AESB-yl
Z
1
/�
� Q i t 1-1
H C Y
4'
CITY
TELEPH�O(NE NUMBER
f
S E tL
Ii4T `Poli -;,-c)
j
1
METER BILE
SERVICE SIZE
CLEARANCE
C D�
STATE LICENSE NUMBER
CITY LICENSE NUMBER
I
I
-2- -'Z!-3-
1[d.
Legal Description of Properly (Show Below or Attach Four Copies)
NJ
TYPE CONNECTION
VERIFIED BY
'I
O
1 1
l
f'
PERC. TEST
PERMIT NUMBER
fG
Q
n
REMARKS
W
,
FI7r TYPECOF CONSTRUCTION STREET IMPROVED
I<a.kj
✓
YES [] I'm
SPECIAL INPECTOR REQUIRED
OCCUPANCY GROUP
EI RESIDENTIAL
GAN
❑
❑ YES,NO
I F ^ a
❑ NEW
LINE
PLAN CHECKED BY
THIS
SITE 15 LOCATED IN THE CITY
NON-RESIDENTIAL
SIGN
OF EDMONDS. LOCAL SALES TAX
ADD
KING
SHOULD BE CODED 3104.
❑ DEMOLISH O WALL
REMAAK9
ALTER EXCAVATE FENCE
ff
I
OR FILL (.......... x .......... Ft.)
..
REPAIR ❑
INSP. a POOL
NUMBER OF STORIES NUa1HER OF
;
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Valuation
FCC
Recelpt No.
11 s'f4.. 4an 1��.{,7*a h- 2 �LeC
....((jj.�
Plan Check No::if.�...7.:.
�
10's-6
E
WAl1 PoI C.
O
�•
�c
S I - / 4F3S�?
BUILDING
v
PRO OHED UBE
- I
PLUMBING
O
PLOT PLAN (Indicate BUilding setbacko, abutting streets)
HEAT d: OAS LINE
FENCE
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
D
I. hereby acknowledge that I have read this application; that the In.
e7
(.,motion given Ie correct; and that I am the owner, or the duly nulhor-
,xed agent of the owner. I agree to Comply With City and ,tate law. regu-
ATTENTION
APPLICATION APPROVAL
lo.ting construction; and In doing the Work i.thorized thereby, no person
Will be employed In violation of the Labor Code of His Slate of Washington
-
TINS PERMIT
This application is not a permit until
relatlog to Workmen's 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 -
y��---"'--
shall be completed in ninety days; hIOVED-IN BUILDINGS shall be nom•
Imowledged in space provided.
pleted in six months.)
HIGNATURE (OWNER OR AGENT) DAT' S10 ED
INSPECTION
Di OR's
a 75
DEPARTMENT
CITY OF
NOTE: Applicalll Subject to Plan Check Fee
EDMONDS
DATE _
I 7 �
1
This Permlt covers work to be done on private property ONLY.
77S-2S2S
Any eons, niellnn onthe public domain (curbs, eldrwniks, drireWay.,
,111 r,ilul rr ,,pool,, pe nile.Inn. a_
i'ILIi