750323.pdfNATURE OF WORK TO BE DONE
Valuation
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flan Check No .....................
BUILDING DEPARTMENT Appuoant Fm
ZONE R PERMIT
20NE 5C NUDiBER -7r)(1323
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BUILDING
PERMIT APPLICATION I Inside Heavy Linea
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ADDRESS
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a, PROPOSED USE
NAME (OR NAME OF DUSINE )
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LOT CO ERA ^• ACTUAL --
LOT COVERAGES LOT COVESiAOE
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MAILING ADDRESS
PERMIUSIBLE HEIGHT 2 O / PROPOSED ISEIOHT Al �'
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CITY �J
TEJ PHONE UMBER
A�1'UAi. LO'[p}Y�A Rsp`E'sJA�1/,`J Tr�� _—� TOTAL BLD!. AREA
/i/�ODEQUIR Afl Utl PROPOSED 1'Al/Da
F tU NT SIDE HEr�AR FRONT
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ES NO PERMIT NUMBER
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CITY
TELEPHONE NUMBEK
STRELYrIt/t
EXISTING S EET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
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RETAINING WALL
NAME
REMARKS
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SWIMMING POOL
DRESS
ADDRESS
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CHECKED BY
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TELEPHONE NUMBER
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DIETER SIZE I SERVICE SIZE CLEARANCE
CHECKED BY
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PRE -MOVE INSPECTION
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
REMARKS
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TYPE CONNECTION VERIFIED BY
TOTAL AMOUNT DUE
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1 hereby acknowledge that I have read this application; that the in-
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formation given le correct; and that I are, the owner, or the duly author-
PERC. TEST PERMIT NUMBER
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ATTENTION
REMARKS , I /�
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FIRE ZZIE TYPED OF CONSHUCTiON STREET IMPROVED]
ILII YES ❑ NO
Will be employed In violation of Ne Labor Cade of the Slate of Washington
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relnting to Workmen's Compensation Insurance.
AUTHORIZES
Signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS whichWORE
ONLY TIIE
�ECIAL INSPECTOR REQUIRED
OCCUPAN_:.Y Gil. UP
NOTED
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ElGASYES
RESIDENTIAL LINE
NEW ❑
NON-RESIDENTIAL
1 1:1BION
® ADD ❑
RETAINING
DEMOLISH WALL
ALTER OR FILLTE ❑ PEN C X. Ft.)
❑ REPAIR ❑
INPPOOL O POOL
PLAN CHECRE Y THIS SITE IS LOCATED IN THE TY
% � OF ED BE COLOCAL DED 31.04. SALES TI AX
REMARKS
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DEPARTMENT
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-
NUMBER OF STORIES NUMBER OF
DB
DWELLING --"
Npplicd)ft Subiert to Plan C!)cck Fce
Thl. i'ennit a• cork lu be done on private property ONLY.
UNITS
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Any <.miD.rfI l on the public dumaln (curb., sidewalks, efirl—y.,
NATURE OF WORK TO BE DONE
Valuation
Fee
Receipt No
'
flan Check No .....................
BUILDING
17— c/� 6
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a, PROPOSED USE
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PLUMBING
PLOT PLA (Indlente Hullding setbacks, abutting streets)
HEAT & GAS LINE
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FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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1 hereby acknowledge that I have read this application; that the in-
formation given le correct; and that I are, the owner, or the duly author-
ized agent of the owner. I agree to comply with city and elate Tawe reg'
ATTENTION
APPLICATION APPROVAL
Inting construction; and In doing the work authorized thereby, no person
Will be employed In violation of Ne Labor Cade of the Slate of Washington
THIS PERMIT
This application is not a permit until
relnting to Workmen's Compensation Insurance.
AUTHORIZES
Signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS whichWORE
ONLY TIIE
uty; and fees are paid, and receipt Is ac -
,hall be completed In nicety day.; MOVED -IN BUILDINGS shall be cam-
NOTED
knowledged in space provided.
pletcd ht months.)
S Ulti: (OWNE Oli AGENT DATE ZONED
INSPECTION
DIRECTOR'S a fA RE
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DEPARTMENT
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,s-
CITY OF
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Npplicd)ft Subiert to Plan C!)cck Fce
Thl. i'ennit a• cork lu be done on private property ONLY.
75.25OTE:
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775.2525
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Any <.miD.rfI l on the public dumaln (curb., sidewalks, efirl—y.,
marquee., ele.) will require separate permission.
FILE
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_ ...USE
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TELEPHONID NUMBER
F
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Gl STATE LICENSE NUMBER
I CITY LICENSE NUMBER
20NE NUMBER -. -: ' ;'J
BUILDING DEPARTMENT Applicant Fill PSC ;. ,
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Plan Check Na .....................
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PERMIT APPLICATION Inside Heavy Lines AD _
I AnonEse J _ (llf�y. �?
❑
VATI,i.IN..
ALTER
❑ ORFILLEXCAVATE
c`E
PENCE
........... Ft.)
0 REPAIR
INNPMOVE
El
NAME (OR NAME OF BUSINE88)
J PERMINtlIBLE ^ ACTUAL
LOT COVERAGE; I�t LOT COY ESYAGE �—
NUMBER OF STORIES NUMBER OF
i
j- .'iJ�-�;:��
/
HEAT & GAS LINE
UNITS
V MAIWNO ADDRESS PERMISSIBLE }fEI611T r^I PROPOSED HEIGHT ^'
•a PLOT PLAN (Indicate Building eetbneks,. n a}ling streets)
21 C'Si�c�
�G
FENCE
O CITY TELEPHONE NUMBER A/�TL LOQ� AREA t _ TOTAL BLDG: AREA
�)�✓LIQ F1'2�Y .__.
SIGN
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�� ,-��/�//�•(,,. / �!=' -' - Rt;VUllt IYAIiUN PROPOSED YARDS
RETAINING WALL
JNAASE"' FRONT W_BEAR FRONT BIDE REAR
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L.GA7. I.OT VAR ANC -f E OR CON 1TIONAL UNE
W
DEMOLITION
ADDRESS l] -YEN NO PERMIT NUMBER
PRE -MOVE INSPECTION
5I,ANIdIN6 EPT. AFI'I O I
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EXCAVATION OR FILL
C CITY TELNUISBEIt
11/1Yl
< STREET p
' EXISTING 8T EET R/W ............FT. DEFICIENCY THIS PROPERTY b
NAME COMP. PLAN ST. R/W ............FT. ............FT. W
A' f� - 'F �� r-1//
TOTAL AMOUNT DUE
,•,
<: <_
: // ` •'L�LG.-. REMARKS
I hereby acknowledge that I have read this application; that the In-
'
ADDRESS
m
formation given le correct; and that I athe owner, or the duly author-
N//A L-Jv
FIRE /Z�1NE TYPFyU=CON; RUCTION STREET IMPROVED
- YES [] NO
SPECIAL INSPECTOR REQUIRED OCCUPr GROUP
[ YES bG O
PLAN CHECKED pY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
m
m
NATURE OF WORK TO SE DONE
a7 CITY
TELEPHONID NUMBER
F
I
Gl STATE LICENSE NUMBER
I CITY LICENSE NUMBER
Legal Description of Properly (Show Below or Attach Four Copley)
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.:. .;' .•�. i -i'-� r _
Plan Check Na .....................
� r% � %�`! n• %�/ 1'7'i- f - U
.fir � t f /�t.,�i/
❑
VATI,i.IN..
ALTER
N//A L-Jv
FIRE /Z�1NE TYPFyU=CON; RUCTION STREET IMPROVED
- YES [] NO
SPECIAL INSPECTOR REQUIRED OCCUPr GROUP
[ YES bG O
PLAN CHECKED pY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
m
m
NATURE OF WORK TO SE DONE
Valuation
Fee
NEW
❑ NON-RESIDENTIAL
❑
SIGN
ADD
.:. .;' .•�. i -i'-� r _
Plan Check Na .....................
❑ DEMOLISH
❑
VATI,i.IN..
ALTER
❑ ORFILLEXCAVATE
❑
PENCE
........... Ft.)
0 REPAIR
INNPMOVE
El
POOL
NUMBER OF STORIES NUMBER OF
DWELLING
I
HEAT & GAS LINE
UNITS
N//A L-Jv
FIRE /Z�1NE TYPFyU=CON; RUCTION STREET IMPROVED
- YES [] NO
SPECIAL INSPECTOR REQUIRED OCCUPr GROUP
[ YES bG O
PLAN CHECKED pY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
m
m
NATURE OF WORK TO SE DONE
Valuation
Fee
Receipt No.
�
.:. .;' .•�. i -i'-� r _
Plan Check Na .....................
BUILDING
.61 40
U 0
PROPOSED USE _ .-
...: /.
PLUMBING
HEAT & GAS LINE
•a PLOT PLAN (Indicate Building eetbneks,. n a}ling streets)
21 C'Si�c�
FENCE
SIGN
RETAINING WALL
N
• I
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
,•,
I hereby acknowledge that I have read this application; that the In-
m
formation given le correct; and that I athe owner, or the duly author-
ized agent of the owner. I agree to comply with city and elate laws regu-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no person
will be employed In vlolnlloa of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen'; Compeneatlon Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt Is ac -
shall be completed In ninety days; MOVED -IN DUILDINOs ;hall be core-
knowledged in space provided.
pleted.ln six months.)'
SIGNATURE (OWNER OR AGENT)'
DATE 816NED
INSPECTION
DEPARTMENT
DIRECTOR'S B NATURE
-
.. ..-.._.._-r.
CITY OF
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EDMONDS
DAT • �
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NOTE: Applicant Subject to Plan Check fee
775-2525
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This Pettit covers wank to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways.
INSPECTOR
mntre—it, eu.) will regmre .ep..tc P-111.0on.