750237.pdfI
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BUILDING DEPARTMENT USE NUMBER 75023%'
AppLcant Fill
PERMIT APPLICATION I Inside Iieavy Lines JOB
ADDRESS
NAME (OR NAME OF HU8INE08) 1 '
lPERM E u OT % j {
/1 n •1 �� r �,.�--� C C IAT COVEROVER LCOAGE LOT COVERAGE
M AMNO ADDRESS "C I i
.t -FI PERMISSIBLE HEIGHT PItOPOOED HEIGHT 7
& (Cn — E7' O /`/ ✓ t �( ST ACTUAL LOT AREA TOTAL BLDG. AREA x
TELEPHONE NUMBER e
DREQUIRED YARDS PROPOSED YARDS �•1
NAME' FRONT BIDE REAR FRONT BIDE REAR
WLEGAL LOT VAI. ANCE OR CONDITIONAL USE
ADDRESS YES [] NO PERMIT NUMBER
E
y PLAN Jq O DEPT. APPROVDAT
q' CITY TELEPHONE NUMBER
<
STREET R/W G
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME COMP. PLAN ST. R/W ............FT. ............FT. WWd
n c� AJ 2 REMARXs F'
D7 ADDItEtlO Z I
I!Ej CHECKED BY 1
F CITY TELEPHONE NUMBER ,X(S/�✓✓ ` I �''
i
U I METER 01'LE I BEHVICE SIZE I CLEARANCE I CKED BY
STATE LICENSE NUMBER CITY LICENSE NUMBER y' j
7� kh)
REMARKS Legal
Legal Description of Properly (Show Below or Attach Four Copies)
I
TYP CONNECTION VER(I1'7EDD�11 !
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PERC. TEST ERWIT NUMBER 11
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yl
11E11ARK9 W �
a
FIRE ZONE ITYPE OF CONSTRUCTION STREET IMPROVED I j
E] YES i] NO !
SPECIAL INSPECTOR REQUIRED I OCCUPANCY GROUP
RESIDENTIAL ❑ GAS DYES ❑ NO 1
NEW LINE PLAN CHECKED Y THIS SITE IS LOCATED IN THE CITY
❑ EDMONDS. LOCAL SALES TAX
NON-RESIDENTIAL SIGN OF
❑ .� H U D BE CODED 31.04.
❑ ADD RETAININGVIM
DEMOLISH
DEMOLISH ❑ WALT /
ALTER ❑ EXCAVATE ElFENCE%'� /<�,�il:� fl,e [rN ('✓i�/J(I (y/w
OR FILL (.....................Ft.)
❑ REPAIR ❑ PRE -MOVE ❑ SWIM // �''LlJG:.1/ O.t.i OL✓ewii✓G JQA��
INSP. POOL SG/•-Sc--.�,
NUMBER O -STORIES NUMBER OF
DWELLING
UNITE �Li/ift? ✓ i?1 it% Sive'/i✓i%�'t?%!R� f
NATURE I
OF WORK TO BE DONE Irt D Valuation Fee Receipt No. -
%- A) L o s` A R 7 V 2 T Plan Check Na .....................
j
[may BUILDING
L PROPOSED USE v
PLUMBING j
G G A 214 C.,
OFLOT PLAN (Indleate Building 9etbncke, abutting street.) HEAT & GAS LINE
» I
FENCE
9ION
2 I
RETAINING WALL
N
SWIMMING POOL
DEMOLITION I
PRE -MOVE INSPECTION'
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I
hereby acknowledge that I have rend t61u appllentlon; that the In-
formation given Is correct; and that I an the owner, or the duly author-
ized agent a[ the owner. I agree to comply with city and state laws regu. ATTENTION APPLICATION APPROVAL
lating construction; and In doing the work authorized 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 -
ONLY TH'
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty, and fees are paid, and receipt is ac-
.h.11
be completed In ninety days; MOVED -IN BUILDINGS shall be com- knowledged in B g provided.
t'llUd In six menthe.)
SIGNATUttE (OWNER . AGE ) DATE SIGNED INSPECTION IDT
O 'S SI NATURE
r DA DEPARTMENT CITYEDMOND$
NOTE: Applicant Subject to Plan Check Fee
775-2525
This Permit curers work /o be done an private property ONLY.
Any ronetruetk` on the public domain (curbs, sidewalks, driveways. FILE
marquees, etc.) .111rrgWre separate permlexkn.
l..
USE PERMIT
BUILDING DEPARTMENT Applicant Fill
ONE NUMBER' - • ��. �?�� ..
PERMIT APPLICATION Inelde Heavy Linos
JOB
ADDRESS
�� ✓ tJ / '."' -' (/ G'( l Go'i'
i
NAME (OR NAME OF BUSINESS)
PERMISSIBLEns ACTUAL -
A)
LOT COVERAGE LOT COVERAGE
.�
AILING ADDRESS t hi
PERMISSIBLE HEIGHT PROPOSED HEIGHT G
'
i nACTUAL
7
j
CIT
TELEPHONE NU B&12
LOT AREA TOTAL BLDG. AREA
S
I)• 1
REQUIRED YARDS PROPOSED YARDS °i
NAME
FRONT SIDE REAR FRONT SIDE REAR
I
LEGAL LOT VARIANCE OR CONDITIONAL USE
ADDRESS
0 YEB NO PERMIT NUMBER
bi
y
PLANN 6 DEPT. APPROVrL
'
C
CITY
TELEPHONE NUMDEtt
II
STREET R/W J p
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME
COMP. PLAN BT. R/W ............p'I'. ........,...FT.
n r• i R
REMARKS
C
A C:
AllDI(Etltl
x
N
GGGlUiii
F(r1
CHECKED BY
CITY
TELEPHONE NUMBER
3
SIZE
SERVICE SIZE CLEARANCE
CFfiECKED BY
-
D
STATE LICENSE NUMBER
CITY LICENSE NUMBER
CITY
�^
I
�•~J
}(� 11k.0
REMARKS
l!" y
Legal Description of Property (Show Below or Attach Four Copies)
/
1:
j
TYP CONNECTION
VERIFIED HY
1
PERC. TESTPERT,jIT
NUMBER a,
N
REMARKS
ce
D
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
f
I C] YES tj NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
p RESIDENTIAL
CA.1
E] LINE LINPLAN
❑ YES a
NEW
CHECKED BY YTHIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
s1aN
OF EDMONDS. LOCAL SALES TAX
ADD
RETAINING
),�.Gf�i%� - -/ SHOULD BE CODED 31.04.
RNMARKS
DEMOLISH WALL
EXCAVATE FENCE
/ C %�J i-'�%%.Q.,N'/! A�.s/�t-/ !: V'%/K�Fl R/Hy' i�% /t -/F, •�
ALTER ❑
OR FILL (..........x..........PLO
❑
REPAIR ❑ PRE -MOVE OIL
INSP. POOL S
)
,Sy"•$(%,t_,/--.�rL f �L-' �-^ (%�/f_l U (.Vh'I.-[.. %✓(/!i ��
NUMBER OF STORIES NUaNUMBEROF
1
DWELLING
UNITS
I
( _ J
Ti :/ /J/(/ ✓l//'F1 �!✓,>'/L�y-:� l/i/.'J S
..
NATURE F WORK TO BE DONE
Valuation Fee Receipt Na.
//��
C_. :J �': e�f''.
R '�.:] i2 (
{._ .Ci /-1
Pian Che 11 No .....................
BUILDING
Cf'
[Oy
¢,
PROPOSED USE
PLUMBING
PLOT PLAN (Indicate Sy\ Inc s,\et.�b 71ting atMeta)
HEAT & GAS LINE
0
FENCE
I ,
SIGN
T
RETAINING WALL
�
N
SWIMMING POOL
DEMOLITION
1 '
PRE -MOVE INSPECTION
y _..._ ...-.
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby ..k.—ledge that I have rend this application; 1661 the In•
t✓
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 elate laws ""_
ATTENTION
APPLICATION APPROVAL
lating can. ructloa: and In doing the wont aulhorlred thereby. no parson
rvlll beemployed In Violation of the Labor Code of the Slate of Washington
THIS PERMIT
This application is not a permit until
,slating to workmen's Compensation Insurance.
AUTIIOittze9
Signed by the Building Official Or his Dep -
NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY TIIE
WORK NOTED
Uty; and fees are paid, and receipt is Be.
.hall be completed In nicely days; MOVED -IN BUILDINGS shall be win-
knowledged In space provided.
Pleted In six months.)
SIONATURE,(OWNER OR AGENTDATE tlIGNED
INSPECTION/
DIRECT2 0 S SIGNATURE /
-'.• /
DEPARTMENT
�l .� .,/
/
CITY OF
EDMONDS
DATE J /
NOTE: Applicant Subject to Pears Check Fre
775-2525
This I'ermll r ren work to he does as private properly ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
INSPECTOR
marquee., etc.) will require n,parme permission.