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BUILDING DEPARTMENT APISH tFill ZONE Rt�� t 1I 1
PERMIT APPLICATION Inside Heavy Linea ADDRESS
2 3122 ?� � • (
p OF HUeINESa) ,(� " ACTUAL
N (\ / /lJl-{. PERM1)VERA ^'y
Cr LOT COVERAGE LOT COVERAGE
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m��ii MAILING ADDRESS , ^� PERM IaBIIII.E }IEIG11'p PROPOSED HEIGHT 1
[ J r(•j' ACTUAL LOT AREA TOTAL BLDG. AREA z
O CITY �� O TELEPHONE NUMBER ',
"•o1d3 PROPOSED YARDS I'
�f/ - •—_ i•-a O REQUIRED YARUB
C G..f'^+'�`•'� FRONT 9IDE REAR FRONT BIDE REAR
NAME �
LEGAL. LOT VARIANCE OR CONDITIONAL USE
y ADDRESS YF.9 NO PERMIT NUMBER
y DATE:
iPLANNING DEPT. APPROVAL !
EPHONE NUMBER
CITY O
EXISTING STREET R/W ............FC. DEFICIENCY THIS PROPERTY
NAME COMP. PLAN ST. R/W ............FC. ............FT. i9
G
ADMARKB i
°x
a AnnRESS fil
i?�4A-CJ, CHECKED BY
F CITY Lr TELEPHONE NUMBER R
z I / /✓r —616 MET. tlIZE I SERVICE SIZE I CLEARANCE I CIIECKED BY
w STATE LICENSE NU� ER� I CITY LICENSE NUM K ,�,,
^(r 23.=z/�— 2 `�/ i� REMARKS
Leg Doecrlptlon of Property (Show 2B.SS.. ori/�;�t�t�•ach FO1/u��r C�/olrp`lee) L
■ / /� S ,S• '32 / / d / � • /v TYPE CONNECTION I VERIFIED HY !
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PERC. TEST 0.' 1
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VOL. F� /` h 2 w
N f REMARKS /f �J. �Er
F� I TYPE O� IITRUC'�ION I a YEST IMPROVEDNO �
� .NJ
SPECIAL INSPECTOR REQUIRED IOCCUPANC ROUP
GAS ❑ YESNO
RESIDENTIAL ❑ LINE PLAN CHECK BY THIS SITE 15 LOCATED IN THE CITY
NEW OF EDMONDS. LOCAL SALES TAX
NON-RESIDENTIAL ❑ SIGN SHOULD BE CODED 31.04.
❑ ADD si DEA10LI8H LiK,AIy NING REMARKS
FENCE ��
ALTER ORFILL(.......... z..........Pt.) �(�//]�/�/�C/� �Jyt/��j/.J��%Q /�/y
E] REPAIR ❑ PRE-NSPMOVE ❑ PSWIMOOL •`.•, ,rI7 �/ - -`A/'O
NUMBER OF STORIES I NUMBER OF '
DWELLING /
UNITS
NATURE-OF WORK TO BE jDONE. %� `��jml1 Valuation Fee Receipt No. _
7�1JQ 1 1 _� Plan Check NO.- .... .............. i
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BUILDING
Y PROPOSED USE
PLUMBING
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PLOT PLAN (Indicate Building setbacks, abutting etrecle) HEAT & GAB LINE
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FENCE 1�I
SIGN
RETAINING WALL
N
SWIMMING POOL qq
DEMOLITION I V
PRE-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A11OUNT DUE arQ O I
I hereby acknowledge that I have read this application; that the In-
formation Kiven Ie correct; and that I am the owner, or the duly author-
Ixed agent of the owner. I agree, to comply wllh city and elate law. raga- ATTENTION APPLICATION APPROVAL .
laud. construction; and In doing the work authorized thereby, no person
a'Ill be employed In Vlolnllon of the Labor Code of the Slate of Weehlagton THIS PERMIT This application is not a permit until
.,.Ueg to Workmen's Compensation lendrance. AUTIIORIZES Signed by the Building Official or his Dep-
ONLYTHE
uty; and fees are paid, and receipt is ac-
NOTE: Permit Limit One Year (Except DEMOLITIONS which \YORK NOTED
shall be completed In ninety day.; MOVED-IN BUILDINGS shall be com. knowledged In space provided. .
pleted In six month".)
CTION
INSPETM
SI�C.,NAJ VItE IVNER 9R AG - 1 DATE LONE DIRECTOR'S ATU
DEPARENT
•OI CITY OF
EDMONDS DATE
NOTE: Applicant Subject to Plan Check Fee 3
775-2525 I
Thls I'rrtnit a re work I. be done un PrlVate le-WaT ONLY.
Any construct,.. on the public domain (curbs, eldew'alks, driveways, FILE
.ur.uee", Ste.) will reeulre Separate perm,"Jon. 1
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BUILDING DEPARTMENT Applicant Fin
USEPERMIT
ZONE7 NUMBER ^t .r j . I • { 1
PERMIT APPLICATION L><°elde IleaYy Lm°°
ADDRESS
NAME
(OR.NAME OF IIUBINE88) r
PI•:ll¢IldBIHLE ^ ACTUAL %
COVEIkAOE
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LOT COVERAOEs LOT
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MAILING ADDRESS ` ( G,
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PERMISSIBLE HEIGHT PROPOSED HEIGHT �' 7
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TELEPHONE NUMBER
ACTUAL LOT AREA TOTAL BLDG. AREA
CITY
REQUIRED YARDS PROPOSED YARDS
BEAR
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r
FILONT SIDE REAR FRONT BIDE
NAME
(.�W
ADDRESS
LEGAL LOT VARIANCE Oli CONDITIONAL USE
YES NO PERMIT NUMBER /
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PLANNING DEPT. APPROVAL DATE.
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CITY
TELEPIiONE NUMBER
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STREET R/W Q
...TIN. STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME :' _i -
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COMP ST. R/W ............FT. ............FT.
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ONNECTION
TYPE CO
VER1FiED BY
PERMIT NUI[HER
PERC. TEST
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REMARKS (
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
,1
-, �_- I YES 0 NO
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SPECIAL INdPECTOR REQUIRED OCCUPANCY GROUP ..
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GAS
RESIDENTIAL ❑ LINE
❑ NEW
❑ YES \Q NO
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
1
1
NON-RESIDENTIAL El SIGN
ADD �I7I DEMOLISH E]RETAINING
lLjWALL
SHOULD BE CODED 31.04.
REMARKS /
�.-f I� /-%�../l/jr
}-j/�)j\j�
FENCE
✓/��5
El ALTER EXCAVATE
R FILL (.......... x.......... Ft. )
❑ OEl
OVE
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REPAIR EJI.RE-
IJ POOL
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NUs[IIER OF STORIES NVDfBElt OF
DWELLING /
I UMTS
NATURE OF NOAIC TO BE NEI
l
Valuation
Fee
Recclnt No.
c)1�.4� I' j r1-11
Plan Check No.....................
BUILDING
PROPOSED USE
a
k�7�
PLUMBING
—
PLOT PLAN (Indicate BUSdmg setbacks, abutting street.)
HEAT & GAS LINE
-
FENCE
1
C
SIGN
i
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
�,(J a
I
I hereby acknowledge that I have rend t61e application; that theIn-
formation given Is correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state law. regu•
ATTENTION
APPLICATION APPROVAL
'
.ating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Cods of the Stale of Washlogton
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Imure ce.
AUTHORIZES
Signed by the Building Official Or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THF.
WORK NOTED
uty; and fees are paid, and receipt is ac
shall be completed In ninety days; MOVED-IN BUILDINGS shall be cam•
knowledged in space provided.
11 led in six months.)
INSPECTION
DIRECTOR'S S 6NATURE+
!
DATE TONED
SIGNATU1tE (OWNER OR AGE N ) 6
I
DEPARTMENT
/
CITYOF
I
DATE _
NOTE: Applicant Subject to Plan Cheek Pee
775.2525
This Permit corers work to he done an private properly ONLY.
(curb,, driveways,
Any construction on the public domain sidewalks,
marquee,, etc.) wilt require separate permission.
INSPECTOR
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