750192.pdfRMT
BUILDING DEPARTMENT ApptleantFIU ZONE NUMBER T
MBER 750192
PERMIT APPLICATION Inside Nervy Lines JOB +��
ADDRESS
N E (OR NAME OF BUSINESS) `T -
LOT CO ERA e'e ACTUAL Y
���r���r. LOT COVERAO& LOT COVERAGE
W MAILING ADDRESS/IJ G O
PERMISSIBLE HEIOIIT PROPOSED HEIGHT i
/L' R�ILEa/'vr �cl� ;�'
TELEPHONE NUMBER ACTUAL LOT AREA TOTAL BLDG. AREA x i
!(Ir���LL�(�[� REQUIRED YARDS PROPOSED YARDS ray
NAME (� dd1/y FRONT BIDE REAR FRONT BIDE REAR
`Imy LEGAL LOT VARIANCE OR CONDITIONAL USE
W ADDRESS ❑ YES [3 NO PERMIT NUMBER ,
PLANNING PT. PPR.VAL DATE
C �1TY TELEPRONE NUMBER
mot
STREET R/{ p
IEUv�'lliA lf'A�n� ��l n EXISTING STREET R/N ............FT. DEFICIENCY THIS PROPERTY
NAME COhrP. PLAN ST. R/W FT.
TALK- REMARKS 'c
I0s� ADDRESS i'
'
U G L �ZJ / CHECKED SY
Sa �a /TEEEPRON13 NUMBER
O 'r"'r`G /ey
M/E(TF.R/SIZE SERVICE SIZE CLEARANCE CHEC D BY
O STATE LICENSE NUMBER I CITY LICENSE NUMBER
/ [F
�� II •, � � � 1.4 �rj� � I 'REMARKS < �
Legal) DD1111lptlon of Property (Show Below or Attach Four Copies) 7/✓ `
TYPE CONNECTION VERIFIED BY
,l
ii PERC. TEST PERMIT N IDE. —'
REMARKS m
I
.Wi FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES 0 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
GAS ❑ YES NO
NEW
RESIDENTIAL F]LINE PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL El SIGN OF EDMONDS. LOCAL SALES TAX i
��'CI SHOULD BE CODED 31.04.
A.-RETAININGLKARKS
E] DEMOLISH El
ALTER EXCAVATE
OR FILL F-1 FEN............. Ft.)PRE-
BIMINI
E] REPAIR . ❑ INSP. El POOL I
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
CITY OF .__�.
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NOTE•: AQplicast SBGject !D Plan Cbrck Fce
This Prrndt nacre work lu be done on private Property ONLY. 775-2525
Any construction on the publle domain (curbs, eblewWke, dliv—sys, FILE
nuvquees, elc.l w111 require separate permleslon. EDAIOND$ DE
7
Check No .....................
BUILDING
(py
W PROPOSED USE
PLUMBING
�, U
—
U
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
FENCE
m
�
SIGN
RETAINING' WALL
N
1
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
-
EXCAVATION OR FILL
TOTAL AMOUNT DUE
C/
I hereby acknowledge that I haus recd this nDPilc¢tlon; that the In.
1
I
formation given Is correct; and that I am the owner, or the duly author.
,Led agent of the owner. I agree to comply with city andaxle Lowe regu-
lating construction; and In doing the work authorized thereby, no Der'
will be employed In violation of the Labor Code of the Slate of Washington
ATTENTION
THIS PERMIT
APPLICATION APPROVAL
This application is not B permit until
-
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
AUTnoRlzeB
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.)
INSPECTION
DEPARTMENT
S16 'U O\VNEA OR T) DATE ONE
iR O SIGNATURE'
CITY OF .__�.
/ w'r1
'
NOTE•: AQplicast SBGject !D Plan Cbrck Fce
This Prrndt nacre work lu be done on private Property ONLY. 775-2525
Any construction on the publle domain (curbs, eblewWke, dliv—sys, FILE
nuvquees, elc.l w111 require separate permleslon. EDAIOND$ DE
7
BUILDING DEPARTMENT Appllnt Fill ONE NUMBE
eaR -7'r;)
1 '»
PERMIT APPLICATION Inside Heavy Lines
NAIiE (OR NAME OF BUetNESBI
MAI NO ADDRESe
4/i . ,
CITY TELEPHONE NUMBER
U
W
F
C
ADDRESS
CITY
C/
or Attacn Four Copie,)
JOB
ADDRESS > //
PERAIItltl1HLE c /ACTUAL
LOT COVERAGE LOT COVESiAOE
PEILMISS113LE HEIGHT PROPOSED HEIGHT
ACTUAL LOT AREA TOTAL BLDG, AREA
REQUIRED YARDS PROPOSED YARDS
FRONT SIDE REAR FRONT SIDE REAR
LEGAL. LOTVARIANCE OR CONDITIONAL USE
fl YES n NO PERMIT NUMBER
E%IBT1N6 B EET A/W ............Ft'. DEFICIENCY THIS PROPERTY
CODfP. PLAN ST. R/W ............FT. ............FT.
REMARKS M !i
70
T—A
D
I -1
F
P T
PERMIT N 1HER
ISV
O
fA
oWe
FIRE ZONE TYPE OF CONBTRUCTIO R T IMPROVED
I
3 YES [] NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
RESIDENTIAL
GAS
❑ YES NO
NEW
LINE
PLAN CHECKED DY
THIS SITE IS LOCATED IN THE CITY
El NON-RESIDENTIAL%
"-
OF EDMONDS. LOCAL SALES TAX
-I-,,''�.:�-.�„
__
BE CODED 31.04.
ADD ❑❑ yALL
R ARK9
.-SHOULD
DEMOLISH
ALTER EXCAVATE ❑ FENCE OR FILL (.....................Ft.)
)
REPAIR ❑ PRE-SIVIM
INSP.MOVE ❑ POOL
J.,
--4-/ �J7`L
0 9,
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
/
Valuation
Fee
Rce,lpl No,
n ` n /�
�/i)J/ �.�Y%? 0 /0-L/G�^17Y
j
Plan Check N. .....................
i
BUILDING'
[O
4 PROPOSED USE
PLUMBING
PLOT PLAN (Indicate Build[ -
HEAT & GAS LINE
5
0
FENCE
SIGN
-I,
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
L•fJ
I';
TOTAL AMOUNT DUE
I hereby acknowledge that I have rend thin appllcntlon; that the In.
formation given le correct; and that I am the owner, or the duly author-
i
Ized 19,11 of the owner. I agree to Comply with city and !tate law, regu-
ATTENTION
APPLICATION APPROVAL
Iating con,tructlon; and In doing the work authorized thereby, no person
!
x•111 be employed In violation of the Labor Code of the Stale of Washington
TIDE 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 nEMOLITiONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is aC-
,hall be completed In ninety days; MOVED -IN BUILDINGS shall he corn.
Imowledged in apace provided.
pleted In .Ix months.)/
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SIGNATURE (OWNER OIL ADEPT)/
(/
/i
DATE jl 6NED
•
INSPECTION
DEPARTMENT
iR1dC,T0 'e SIGNATURE
I
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�i :,/,•:• X- I.rii.t..✓
'�--l�cr)J,� 1 -
CITY OF
E
NOTE: Applicant Subject to Plan Check Pee EDBIONDS
This I.—It r Work 1. be don. o 775-2525
n Priv.t. proMrlY ONLY.
/
Any con.zruellmt` an the public domain (curb.• sidewalks, drlre~,, ` INSPECTOR
ntarpuers, elect will Meulr. n,par.ls, permi..lan.