750234.pdfBUILDING DEPARTMENT Applicant FIB
PERMIT APPLICATION I Inside Heavy Lines
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NAME (OR NAME OF BUSINESS)L
ADDRESS 21913 -76th
Avenue West
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Northwest Bonded Mtg.
LOT O ERA E
LOT COVERAGE
ACTUAL J
LOT COVERAGE
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11
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MAILING ADDRESS
10314 Aurora Ave. North
PERM IHHIHLE FIEIOItT
PROPOSED HEIGHT
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CITY
Edmonds, Washig ton
TELEPHONE NUMBER
ACTUAL LOT AREA
REQUIRED YARDS
TOTAL BLDG. AREA
PROPOSED YARDS
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NAME FRONT SIDE REAR FRONT HI_DN REAR
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y'PLANNING
LEGAL LOT VARIANCE OR CONDITIONAL USE
ADDRESS C3 YE e NO PERMIT NUMBER
DEPT. APPROVAL DATE:
CITY TELEPHONE NUMBER
STREET R/W
E XIeTING STREET R/W ..........,.FI'.
DEFICIENCY Tills PROPERTY
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COMP. PLAN 8T. R/W ............P'I'.
............FT.
REafARKS
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ADDRESS
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CHECKED BY
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CITY
I TELEPHONE NUMBER
METER BILEI SERVICE SIZE
CLEARANCE
CHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUMHEtt
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REMARKS
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Legal Description of Property (Show Below or Attach Four Copies)
Lot 2, Block 2 Pine -Land Addition
TYPE CONNECTION
VERIFIED BY
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WREMARKS
PERO. TEST
PERMIT NUMBER
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FERE ZONE I TYPE OF
CONSTRUCTION STREET IMPROVED
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❑ YES [] NO
SPE(IIAL INSPECTOR REQUIRED OCCUPANCY GROUP
RESIDENTIAL ❑ GAS
NEN PINE
NON-RESIDENTIAL SIGN
ADD RETAINING
DEMOI.iBII WALL
ALTER EXCAVATE FENCE
❑ YES NO
PLAN CHECKED DY
REMARKS
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS, LOCAL SALES TAX
SHOULD eE CODED 31.04.
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❑ OR FILL (.......... It .......... FL)
❑ REPAIR ❑
INSP. El POOL
NUMBER OF BTOIi1R8 NUMBER OF
DWELLING
I
UNITS
No.
1
NATURE OF WORK TO HE DONE
COMPLIANCE INSPECTION.
Plan Checl< No
Valuation
Fee Receipt
.....................
BUILDING
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PROPOSED USE
PLUMBING
PLOT PLAN (Indlcgte Building setb¢eke, abutting streets)
HEAT A GAB LINE
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FENCE
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SIGN
RETAINING WALL
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eWIINMING POOL
DEMOLITION
PRE -MOVE INSPECTION
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EXCAVATION OR FILL
COMD. Ins .
25.00
I hereby acknowledge that I have read this application; that the In-
TOTAL AMOUNT DUE.
25.00
formation glvon Is correct; and that I un the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state law. regu-
laling construction; and In doing the work authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
will be employetl In violation of the Labor Code of the Slate of Washington
relating to Workmen's Compensation Insursnce.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
THIS PERMIT
AUTHORIZES
ONLY Tit"
WORK NOTED
This application is not a permit until
signed by the Building Official or his Dep -
uty, and fees are paid, and receipt is ac -
shall be completed In ninety days; MOVED -IN BUILDINGS shall be corn.
pitted In six months.)
knowledged in apace provided.
SIGNATURE (OWNER OR AGENT) DATE SIGNED
Northwest Bonded Mtg. 5-21-75
INSPECTION
DEPARTMENT
CITY OF
Dl Oft's a GNATU E •I
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- (1%'(.L.fi ' ✓ / /; / �ti
NOTE: Applicant Subject to Plan Check Fee
EDMONDS
775-2525
DAM
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This Permit rneers work to be done on private properly ONLY.
Any construction on Ilse public domain (curbs, sidewalk., driveway.,
marquees, tic.) will require ..p -.Ie permission.
FILE
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O STATE LICENSE NUMBER
i CITY LICENSE NUMBER
REMAAKS
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Legal Description of Properly (Show Below er Attach Four Copies)
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VERIFIED BY
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USE ERMIT_
7234
BUILDING DEPARTMENT Applicant Fal
ZOO NUMBER
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Inside heavy Lines
PERMIT APPLICATION
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ADDRESS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
"
YES [3 NO
11413-761 h AVflntlU gest
SPECIAL INSPECTOR REQUIRED
GROUP
NAME (OR NAME OF BUSINESS)
PERa7ISBIBLE ACTUAL y
,
PLAN CHECKED BY
!�'ir i'!1'n'•::_ f ri)nt.i L'�1 %�'�"1 -
LOT COVERAGE LOT COVERAGE
MAIL(NO ADDRESS
PERMISSIBLE HEIGHT PROPOSED HEIGHT
NUMBER OF STORIES NUMBER OF
Anrc)ru
DWELLING
�
ACTUAL LOT AREA TOTAL DL➢O. AREA
CITY T LEPHONE NUMBER
NATURE OF WORK TO HE DONE
il'•!` L i FtiJC:E t rls� .cT 1 ON
Plan Check No .....................
�'I3SI1 I nC;tC)11
BUILDING
REQUIRED YARDS PROPOSED YARDS
[0y
L PROPOSED USE
PLUMBING
FRONT SIDE REAR FRONT SIDE REAR
HEAT & GAS LINE
FENCE
NAME
N
LEGAL LOT VARIANCE OR CONDITIONAL USE
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N
ADDRESS
0 YES [3 NO PERMIT NUMBER
F
y
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PLANNING DEPT. APPROVAL DATE:
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CITY
TELEPHONE NUMBER
R/W
!
EXCAVATION OR FILL
STREET
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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I nsu.
NAME
COMP. PLAN ST. A/W ............FT. ............FT.
formatlon given is correct; sad that I a n the owner, or the duly author-
Cl f'7S r
WAS
REMARKS
APPLICATION APPROVAL
will be "Played In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
ra)e.tlag to Workmen's Compensation Insurance.
w
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be campicted In ninety day.; MOVED -IN BUILDINGS shall be cam"
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt Is ac -
knowledged In space provided.
CHECKED BY
l
SIGNATURE (OWNER OR AGENT) DATE SIGNEU
,.r'Nre•„ s,:�n,l-:;d 11 �'''�
CITY
TEL�EPHONE NUMBER
DATE
NOTE: Applicant Subject to Plan Check Fre
EDAIONDS
775-2525
INSPECTOR
This Permit corere work to be done on private property ONLY.
Any con.iructlan an the public domain (curbs, sidewalks, drive,"..
marquees, etc.) will require tep—ts permission.
-71 G -1/L
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r
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
O STATE LICENSE NUMBER
i CITY LICENSE NUMBER
REMAAKS
Legal Description of Properly (Show Below er Attach Four Copies)
Lot 2, UIock 2 Pine -Land AdditionT
P C_O N T
VERIFIED BY
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES [3 NO
SPECIAL INSPECTOR REQUIRED
GROUP
GAS
RESIDENTIAL E] LINE
El NEW
El NON-RESIDENTIAL SIGN
ADD❑ WAIAI.'NINC
1:1 DEMOLISH
RFILL EXCAVATE ❑ PENCE
ALTER ❑ ORx .......... Ft.)
❑ YES ❑ NO
(OCCUPANCY
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
BE S. LOCAL SALES TAX
SHOULDOFEDM
SHOULD 8E CODED 31.04.
REMARKS
REPAIR PRE-❑
INSP. El POOL
NUMBER OF STORIES NUMBER OF
„
DWELLING
UNITS
Valuation Fee Receipt No.
NATURE OF WORK TO HE DONE
il'•!` L i FtiJC:E t rls� .cT 1 ON
Plan Check No .....................
BUILDING
[0y
L PROPOSED USE
PLUMBING
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s�e`tb`ncke,_gbulting streets)
PLOT PLAN (lntllcnt\o Hulitlrin6/+.
O \ �l` T /"-� `�
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
2.5. UQ
I nsu.
")5. 00I
TOTAL AMOUNT DUE
hereby acknowledge that I have read this application; that the In-
formatlon given is correct; sad that I a n the owner, or the duly author-
ized agent or the owner. I agree to comply with city and state I— regu-
,sting construction; and In doing the work authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
will be "Played In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
ra)e.tlag to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be campicted In ninety day.; MOVED -IN BUILDINGS shall be cam"
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt Is ac -
knowledged In space provided.
Pleted In six month..)
SIGNATURE (OWNER OR AGENT) DATE SIGNEU
,.r'Nre•„ s,:�n,l-:;d 11 �'''�
INSPECTION
DEPARTMENT
CITY OF
DIl2EQ� OR'S �lONATU�E ;) J
f,_LP-(•L/J": - !Iii a
DATE
NOTE: Applicant Subject to Plan Check Fre
EDAIONDS
775-2525
INSPECTOR
This Permit corere work to be done on private property ONLY.
Any con.iructlan an the public domain (curbs, sidewalks, drive,"..
marquees, etc.) will require tep—ts permission.
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