750251.pdfBUILDING DEPARTMENT FW
ONENUMBER 750251
Applicant
PERMIT APPLICATION Inside iionvy Linos
JOB
ADDRESS / �f
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NAM
(OR NAME OF BUSS SS))
/PEIt,COVE A � .� 0/D ACTUALLOT COVERAGE LOT COVESFAOE
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TE PHONE NUMHa.R
ACTUAL LOT AR�E}A-r TOTAL LDG. AREA O
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FIlONT HIUE REAR FRONT SIDE REAR I
NAME
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ADDRESS
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TELEPHONE NUMBER
CITY
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R°nlwRxe Driveway slopes not to exceed those
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indicated on Standard Dwg. No. 103.
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REMARKS
Legal DozeriPUo of Property (8ho Below or Attach Fou[ CODles/
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TYPE CONNECTION
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PERC. TEST
PERMIT NUMBER
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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SPECIAL INSPECTOR J/ F4UIRED OCCUPANCYrGROUP
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RESIDENTIAL
GAS
❑ LINE
❑ YES
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PLAN Bj IN THE CITY
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CHECKED THIS SITE IS LOCATED
LOCAL SALES TA%
❑ NON-RESIDENT]
❑ BICN
'L �L�'L� OF EDMONDS.
HOUL BE CODED 31.D4.
ADD F1 DEAfOLISH RETAINING
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ARK9
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ALTER EXCAVATE FENCE
OR FILL (.....................Ft.)
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INSP. POOL
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14UAIBEII Oh'BTOR3 ES
NUMBER OF
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DWELLING
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NATURE or WORK TO BE DONE60
Valanllon
Fee
Receipt No.
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PCheck Nn.....................
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DUILDING
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PROPOSED USE
PLUMBING
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aPLOT
PLAN (IndlCatO Sulming setbacks, nbultmB weete)
HEAT A GAB LINE
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FENCE
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SIGN
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RETAZNIN6 WALL
N
SWIMMING POOL
DEMOLITION
PRE-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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1 hereby aeknowledge 11.1 I have read lite ODPllcetlan; that the In-
formation glean le correct; and that I afa the owner, ar the duty aulhor-
Ized agent of the owner. I naree to comD)y with city and ,tate law, regu.
ATTENTION
APPLICATION APPROVAL
IaIInB construction; and In doing the work authorized thereby, no Dereon
will be employed In vlolatlon of the Label Code of the elate of Wa,hingion
THIS I-ER511T
This application is not a permit until
relating to Workmen', ComDene.tlaa Insurance.
AUTHORIZEB
signed by the Building Official or his Dep-
NOTE: Permit limit One Year (E—Pt DEMOLITIONS Which
ONLY Tu '
WORK NOTED
uty; and fees are paid, and receipt is ac-
Ibe completed In ninety aye; MOVED-IN BUILDINGS shall be Com"
knowledged in space provided.
plet d In I% rnontIV.)
INSPECTION
DEPARTMENT
DIRE O H SIGNATURE
qTU E (OWN It O A ENT) DAT1G ED
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CITY OF
F.D31fONDS
ATE
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NOTE: A(1(5licant Subject to Plan Check Fee
775.2525
This Permit covers work to IM done an private property ONLY.
Any conetructlan on the publle damaln (enrbe, Sidewalks, drheway,,
FILE
marquee,, rle.l will require separate permis,lon.
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B U I L D I N G DEPARTMENT qnn licant FLI1
UeE-� PERMIT--
ZONE=; `. I i- NUMBER
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PERMIT APPLICATION I Inside Heavy Uses
to
ADDRESS '" A A •7
C(-•�✓
NAME OF BUB1NEBS)
/ 'ir/ ��" -� / (' ✓•' i�/ i�1'
NAME (OR
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PERMId87HLE ^ C��
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IAT COVERAOLOT COVAGE 11
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MAILING ADDRESS
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PERMISSIBLE }IEIO)IT_, PROPOSED HEIGHT ) •y /
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CITY TELEPFFONE NUMBERt-j
ACPUAL LOT AREA TOTAL BLDG. AREA ,
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REQ IIII.D YA RDd PFtOP08ED YAROH
NAME
FRONT BID),REAR FRONT BIDE REAR
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LEGAL, LOT VAIt ANLL OR CONDITIONAL Ue£
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ADDHEBB
p•YKS 0 NO PERMIT NUMBER
IL MNGDEPT. A ROVAI{ DATE:,
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CITY TELEPHONE NUMBER+
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6TREETR/``\V ]]
EXISTING STREET R/W A.q.FT. DEFICIENCY// HIS PROPERTY
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NAME
// ...1. ..FIT.
COMP. PLAN ST. R/W
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REMARKB
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ADDRESS
indicated J'il tat inC137'd UWr. ILO, 103.
CHECK'ylyE1.D"A,�BY
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CITY.
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METER SIZE HERVICE 812E CLEARANCE
CHECK D BY
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LICENSE 14UM
CITY LICENSE NUMBER
/STATE IBE.
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REMARKd
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Legal Descrlpllon of Property (Show Below or Attach Four Copies)
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TYPE C'ONNECTION
VERIFIED BY
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PERO. TEST
PERM IT NUMBER
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FIRE ZONE
TYPE OF
CONSTRUCTION
I STHEE'f
,
IMPROVED
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NES ❑No
SPECIAL INSPECTOR REQUIRED
OCC/UPANCYf-GROUP
RESIDENTIAL
GAS
LINE
OYES
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ED NEW
PLAN CHECI(ED BY THIS SITE IS LOCATED IN THE CITY
) TAX
NON-RESIDENTIAL
BION
OF EDMONDS. LOCAL SALES
[[ /
�1 •ri�./ J,f11X BE CODED 31.04.
ADD
RETAINING
,?.t LHOl1LD
REMARK
WALL
DEMOLISH
EXCAVATE FENCE
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���(!�✓'1l ,Ei`vii ��✓�' /�1�-�� V�I'li �/f'/�~
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ALTER
OR FILL(..........x.......... Fl•)
— -
PRE-24OVE BWIM
REPAIR POOL
INBP.
❑ ❑
— -% —
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"�'*' � ,
NUMBER OF STORIES NUd"" OF
DNELLING I
1
UNITS
1
NATURE OF WORK TO BE D6ON�+tEpp
ValuationFee
Recelpt No,
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Plan Check Nn.....................
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`.. i"\il ��.r I�G��1��`l�`--�•'
BUILDING
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PROPOSED UBE:
PLUMBING
�•�) �' u
HEAT d: GAS LINE
5 G�-'
PLOT PLAN (Indicate Building setbacks, abutting streets)
O
4 <j
FENCE
1
tRETAINING
SIGN
WALL
N
SWIMMING POOL
I
DEMOLITION
f
PRE-MOVE INSPECTION
EXCAVATION OR FILL
I
TOTAL AMOUNT DUE
i
I hereby acknowledge that I have read this application; that the In.
-
formation given In correct; and that I am the owner, or the duly author-
j
fxed agent of the owner. I agree to comply with city and state law. rego-
ATTENTION
APPLICATION APPROVAL
I
Ialing construction; and In doing the work authorised thereby, no person
will be e'Played In violation of the Labor Code of the State Of Wasblagton
TIDE PERMIT
This application is not a permit until
j
relating to Workmen's Compensation Insurance,
AUTIIOIU ES
signed by the Building Official or his Dep-
I
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
j
shall be completed In ninety day.; 31OVED-IN BUILDINGS Shall he cam-
Imowledged in space provided.
pleted In six month..) i
SIGNATURE (OWNER OR AGENT) r DATE SIGNED
INSPECTION
DIRECTOR'S SIGNATURE ,
I
DEPARTMENT
•,
CITY OF
EDMONDS
HATE I
1
-
NOTE: Applicawt Subject to Plan Check Fee
-•• ', -� - ,/ ,'->
77S-2S2S
Title Permit eullre work to be done on private property ONLY.
Any construction on the public domain (rurb., sidewalk., drhewvays,
INSPECTOR
nlusquee., etc.) will require separate pernll.slon.
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