750153.pdfN
USE PERI
153
BUILDING DEPARTMENT
ZOHE NUMBIEn
;1
Applicant Fill
PRE -MOVE INSPECTION
PERMIT APPLICATION I Inside Heavy Lines
JOB
Comp. Insp.
ADDRESS
8124 Sierra Drive
25.00
TOTAL AMOUNT DUE
NAME (OH NAME OF BUSINESS)
ACTUAL
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Columbia Mortgage g Inv., Ince
LOT COVERAGLOT COVERAGE
formation Riven le correct; and that I athe owner, or the duly author.
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MAILING ADDRESS
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ATTENTION
PERNI9BIBLE HEIGIIT PROPOSED HEIGHT
2150 North 107th Street
2
CITY
will be employed In violation of the Labor Coda of the Slate of Washington
THIS PERMIT
O
TELEPHONE NUMBER
ACTUAL LOT AREA TOTAL BLDG. AREA
S
ONLY THE
WORK NOTED
Seattle, Washington I
365-9400
REQUIRED YARDS PROPOSED YARDS
a
pleted In elx mon the.)
NAME
SIGNATURE (OWNER OR AGENT) DATE SIGNED
I
FRONT SIDE REAR FRONT SIDE REAR
DI OR's SIONATUF�E
It/e/qF /' 1
CO I umb 1 a Mortgage Inc. 4- 14-75
Columbia
98133
°f. 'q
CITY OF/�l.
WADDRESS
LEGAL LOT VARIANCE OR CONDITIONAL USE
EDMOND9
DATEr
NOTE: Applicant Subject to Plan Cheek Fee
0 YES C] NO PERMIT NUMBER
.M
PLANNING DEPT. APPROVAL DATE:
This 1'erndt clcork to be done on private property ONLY.
V
N CITY
TELEPHONE NUMBER
FILE
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STREET R/W
C
EXISTING STREET R/w ............PT, DEFICIENCY THIS PROPERTY
NAME
COsrP. PLAN ST. R/W ............ FT. ............FT.
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REMARKS
t
ADDRESS
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V
CITY
TELEPHONE NUMBER
IOHECKED
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METER BILE
SERVICE SIZE
CLEARANCE
CHECKED BY
O 9TAT'E LICENSE NUMBER
CITY LICENSE NUMHElt
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([dr
REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
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Lot 26, Sierra VIII age Division tl Bit
TYPE CONNECTION VERIFIED BY
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PERC. TEST
PERMIT NUMBER
d.
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67
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION
STREET IMPROVED
YES [] NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY
GROUP
RESIDENTIAL
GA8
❑ YES I] NO
I
E]NEWE]LINE
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
EDNON-RESIDENTIALElBTON
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
❑ ADDRETAINING
❑ DEMOLISH ❑ WAIT'
REMARKS
❑ ALTER
F1(FENCE
❑ ORFILL........... Ft.)
❑ REPAIR ❑ PN -MOVE El SWIM
P. POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORT{ TO 13E DONE
Valuation
Fee Receipt No.
COMPLIANCE INSPECTION
Plan Check Ne .....................
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•,
BUILDING
PROPOSED USE
a
PLUMBING
U
PLOT PLAN (Indlcnle BUllding aclbaeke, nbutling eUeete)
HEAT k GAS LINE
9
FENCE
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SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Comp. Insp.
25.00
TOTAL AMOUNT DUE
1 hereby acknowledge that I have read this aDPlicatlon; that the In.
25.00
formation Riven le correct; and that I athe owner, or the duly author.
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I,rd agent of tha owner. I agree to comply with city and state lawn regu-
ATTENTION
APPLICATION APPROVAL
lating conetruetlon; and In doing the woric authorised thereby, no person
will be employed In violation of the Labor Coda of the Slate of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Imurmee.
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-
shallhe completed In ninety days; MOVED -IN BUILDINGS shall be coin.
knowledged in apace provided.
pleted In elx mon the.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
I
INSPECTION
DEPARTMEIJT
DI OR's SIONATUF�E
It/e/qF /' 1
CO I umb 1 a Mortgage Inc. 4- 14-75
Columbia
°f. 'q
CITY OF/�l.
(/II^
EDMOND9
DATEr
NOTE: Applicant Subject to Plan Cheek Fee
775-2525
3
This 1'erndt clcork to be done on private property ONLY.
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Any e—tructlena lite public domain (curbs, sidewalks, driveways.
FILE
r,lurr.. .•1 c,1 ,.III —p-, —1--, nUeslon.