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UeE,� PERMIT
NUMBER 750206
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BUILDING DEPARTMENT Applicant FillZONE
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PERMIT APPLICATION Inside Ileavy Lines
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NAME ON HUtlINE88)ADDRESS
20 7'
NAME (OR
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AL �/AbSEaT
PERM IES ULE 7o p ACTUAL
IAT COVERAGE �j�/m LOT COVE AOE
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-AN {�
MAILING ADDRESS
YEItN IeSIBLE HFIOIIT PROPOSED HEIOHI'
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12041 _rj - -T-7 Y N iQV 1G W.
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CITY
TELEPHONE NUMBER
UA REA TOTAL BLDG. AREA
1
�DMONDS
778 - 5095
REQUIRED YAR US PROPOSED YARDS
NAME
FRONT SIDE HEAR FRONT HIDE 7 REAR
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EGAL LOTVA A CE Ofi CO UI NAL USE
ADDRESS
YE NO PE 1 NU1.1BER
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PL DEPT APYRO ` - G•T
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CITY
TELEPHONE NUMBER
ETRE A/\V
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EXIHTING STREET R/W ...........FI'. DEFICIENCY THIS PROPERTY
NAME
COMP. PLAN BT. R/W ....... .....FT. ............FT.
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REMARKS
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ADDRESS
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CITY
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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Legal Description of Property (Show Below or Attach Four Copies)
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TYPE CONNECTION
VERIFIED
AS i" V. 22 - E Z5
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PERC. TEST
I PERMIT
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REMARKS
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FIRE E TYPE OF� BTRUL�iON STYEBT IM
I I Q NO
SPECIAL INSPECTORREQUIRED OCCUPANCY GROUP
YES *46
RESIDENTIAL
GA8
❑ LINE
❑ .,y.
PLAN CHEC D�Y
NEW
THIS SITE IS LOCATED IN THE
NON•REBIDENTIAL
❑
ALES TAX
DS.CO
C/iJ/.4tL�✓ SHOULD
SIGN
BE ED 3AU4
® ADD ❑ ❑ RETAINING
ARKS
DEMOLISH
FENCE
El
�// C6�1 ,tiL/Gv iJ.t/ Qd/ adC 19 7.3
ALTEREXCAVATE
❑ OR FILL (.....................Ft.)
_
SWIM
❑ REPAIR
.
❑ INBPaCOVE ❑ POOL
cJ �LA•/ G.�'� J V 61-)
NUMBER OF STORIES NUMBER OF
DWELLING
I
I UNITS I
NATURE OF WORK TO HE DONE
Valuation Fee Receipt
No.
1✓ t l AR�� FAt✓1i�Y ROGN�
Plan Cheek Nn .....................
z
BUILDING
9 ac
[may
F PROPOSED USE
V
Re�l�r✓NriA�.
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT k GAS LINE
j cS c.JE sk�TcH
FENCE
SIGN
tRETAINING
WALL
—
N
SWIMMING POOL
DEMOLITION
,
PRE -MOVE INSPECTION
EXCAVATION On FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that We in-
formallon given Is correct; and that I am the owner, or the duly author -
1.1d agent of the owner. I agree to comply with city and state laws regu•
ATTENTION
APPLICATION APPROVAL
luting construction; and In doing the work allthorlred thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application Is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS whleh
ONLY THE\\'ORIC NOTED
yi t' ut and fees are paid, and receipt Is ac -
shall be completed in ninety days; alOVED-IN BUILDINGS shell be cem-
knoWledged In space provided.
pleted In six months.)
-
SIGNATURE (OWNER OR AGENT)
DAT 0I6IIr�jjEU
INSPECTION
DEPARTMENT
t'S IGN TUR
CITY OF
NOTE: Applicant Subject to Plat Check Fee
EDMONDS
ATE
S —
+----
775.2525
This I'ennil em'en work to ba done on private properly ONLY.
Any conetructlou on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permlerlon.
FILE
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BUILDING DEPARTMENT I Applicant Fill "aNE `J NUSt 750206
�--1
PERMIT APPLICATION Inside Heavy Lines
NATURE OF WORK TO HE DONE
NAME (OR NAME OF BUSINESS)
Valuation Fee Receipt No
! • �IAi�St=T
MAILING LING ADDRESS
SS
4' CITY
PLANNING nEPT.
TELEPHONE NUMBER' - _� ' •- / r
' ..
CITY
TELEPHONE NUMBER
1=;D1"\ ;'WDS
77b-5095
l( NAME
s
aUj l DRE88
JO
ADDRESS o /� /..,� — 1 J WVi l,!f. •L
PERMIHHLE IB ^ ..tt------ ,1 ACTUAL p
LOT COVERAGF• LOT COVESYAGE
PERMI..IBLE HEiunw;a ri-PouND HEIGHT
ACCUAL,DOZ'EA TOTAL BLDG. AREA I'2,�f�
REQUIRED YARDS PROPOSED YARDHEE^D YARDS PROPOSED YARDH
PIiONT SIDE REAR FRONT .SDE REAR
�EOAL LOT VA ANCE OR CO DI ♦AL USF.
YEs' NO PERM NUMBER
O
r-egat Description or Property lemow Below or Attack Four Copies)
Lar Iy - EDGr-- woOD MALIo(-4
z
%\ RCCofdD D Itis V. 22 - P 25
a
�F_GOCLf�S Sr�oNOntlsla Co. WiQ
j
RESIDENTIAL GAS
LINE
NEW
NON-RESIDENTIAL
ADD SIGN.,��)�
❑ RETAINING
❑ DEMOLISH WALL
ALTER ❑ EXCAVATE ❑ FENCE
OR FILL (.......... x .......... Ft.)
PRE -
REPAIR ❑ N P. O POOLI
NUA/BEii OF 8TOR1E9 NUMBER OF
I DWELLING '
UNITS
FIRE 1111 1 TYPE OF CONST,RUCCTION STREET IMPROVED
YES NO
SPECIAL INSPECTOR REQUIRED I OCCUPANCY GROUP
❑ YES
PLAN CHECK D Y
_ THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
;tom„( Y'Ll,�•� SHOULD BE CODED 31.04.
REMARKS ri
L'
/� (. C•'%✓%! �_.•
NATURE OF WORK TO HE DONE
Valuation Fee Receipt No
r r_. t tar, r rAN11L.\{ F:�,car✓t
4' CITY
PLANNING nEPT.
TELEPHONE NUMBER' - _� ' •- / r
' ..
NBUILDING
STREET K/t
O
EXISTING STREET R/W
..(DEFICIENCY THIS PROPERTY
PLOT PLAN (IndlWt Hulltl\g(getbacitq,_Abutting street.)
,Ti
NAME
COMP. PLAN HT. R
.........
............FT.
............FT.
FENCE
�........FT.
W
--- ow 1J � R
REMARKS
RETAINING WALL
"I
Is V ADDRESS
e{YIMMINO POOL
CHECKED BY
DEMOLITION
W
PRE -MOVE INSPECTION
CITY
TELEPHONE NUMBER -
TOTAL AMOUNT DUE
OG
S hereby acknowledge that I have rend this application; that the In -
F
Z
I
Ized agent of the owner. I agree to comply with city and elate lawn ragu-
ATTENTION
APPLICATION APPROVAL
rating construction; and in doing the work authorised thereby, bo person
AtET 8 G' y
Z' r AN
Ting PERMIT
This application Is not a permit until
r-egat Description or Property lemow Below or Attack Four Copies)
Lar Iy - EDGr-- woOD MALIo(-4
z
%\ RCCofdD D Itis V. 22 - P 25
a
�F_GOCLf�S Sr�oNOntlsla Co. WiQ
j
RESIDENTIAL GAS
LINE
NEW
NON-RESIDENTIAL
ADD SIGN.,��)�
❑ RETAINING
❑ DEMOLISH WALL
ALTER ❑ EXCAVATE ❑ FENCE
OR FILL (.......... x .......... Ft.)
PRE -
REPAIR ❑ N P. O POOLI
NUA/BEii OF 8TOR1E9 NUMBER OF
I DWELLING '
UNITS
FIRE 1111 1 TYPE OF CONST,RUCCTION STREET IMPROVED
YES NO
SPECIAL INSPECTOR REQUIRED I OCCUPANCY GROUP
❑ YES
PLAN CHECK D Y
_ THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
;tom„( Y'Ll,�•� SHOULD BE CODED 31.04.
REMARKS ri
L'
/� (. C•'%✓%! �_.•
NATURE OF WORK TO HE DONE
Valuation Fee Receipt No
r r_. t tar, r rAN11L.\{ F:�,car✓t
Plan Check No..- ................
NBUILDING
4 PROPOSED USE
PLUMBING
PLOT PLAN (IndlWt Hulltl\g(getbacitq,_Abutting street.)
HEAT @ GAS LINE
FENCE
SIGN
RETAINING WALL
N
e{YIMMINO POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
OG
S hereby acknowledge that I have rend this application; that the In -
/r
formation given In correct; and that I am th. owner, or the duly author.
Ized agent of the owner. I agree to comply with city and elate lawn ragu-
ATTENTION
APPLICATION APPROVAL
rating construction; and in doing the work authorised thereby, bo person
will be employed In violation of the Labor Code of the Slate of Wand lagto ,
Ting PERMIT
This application Is not a permit until
relating to Warkmen'n Compensation Insurabce.
AUTHORIZES
signed by the BuildingOfficial or his De -
Dep
Permit Limit One Year (Except DEMOLITIONS Which
ONLY
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt Is ac -
.hall be completed In bluely days; MOVED -IN BUILDINGS shall be arm-
-
knowledged in space provide&
pleted In six months.)
SIGNATURE (03yNEII OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
-. -
DIRE TOR'S BIGNATURE)� t
/, = y l
1,
CITY OF
' Y �..' 1 if ,��./ ! .
EDMONDS
DATE j /
NOTE: Applicant Subject to Plan Check Fee
C—
775-2525
Thi. Permit e n work to be don n privet. property ONLY.
Any conslructionque on the sidewalks. drirewgn,
pwillc
c. equine ecurbs, PermNRa,
marquees, Stool w1i1 require separate ncrmlesion.
- INSPECTOR