750413.pdfVALUATION FEE
PERMIT
ZONE NUMBER
750413
PLAN CHECH
JJtt''77
BUILDING DEPARTMENT Applicant Fin
NO.
/L
1
PERMIT APPLICATION Inside Heavy Lines
D
ABUTTING STRESTSI
BUILDING
ADDRESS /1�
AO-
PLUMBING
O
NAME NAME OF SU ESS)
to
HEAT & GAS LINE
O
LOT
LOT AREA
SUBDIVISION NO,
FENCE
q
a
ZLEGAL
MAILING ADO ESB
❑ YES ❑ NO
RETAINING WALL
i
W
Z
('� /�J '
VARIANCE OR
GOND. USE NO.
ADS NO.
1
I{
O
CITY
TELEPHONE NUMBER
hereby acknowledge that i have read this application; that the In•
on given la correct; and that I nm the owner, or the duly author•
Z
.I
ent of the owner. I agree to eomD1Y with el Ly and &tat e laws ngu•
thereby, no
ATTENTION
2>^2,
PROPOSED YARDS
HEIGHT
Z
to workmen'. Compenaatlon Ina( ence,
r
AUTHORIZES
mytpq+Q�,
: Permit Limit One Year (Except DEMOLITIONS whichWORK
FRONT SIDE REAR
Utyi and fees are paid, and receipt is ac -
Z
I
knowledged in space provided.
NAME
URE NE O�RAG ENT) DATE SIGNED
DEPARTMENT
t.
,.. Z
P-7 s
JEDMONDS
ALLOWABLE
SIGN AREA
PROPOSED
SIGN AREA
C
U
N li: Applicant SuG%ect ti Plan Check ree
GATE —7 �
t
I-
ADDRESS
OTHER
ORIGINAL . Filc YELLOW - Insl�cucr
Any construction on public
marquees, etc.( will require separate permission.
i
=
REQUIREMENTS
R
CITY
TELEPHONE NUMBER
PLANNING DEPT. APPROVAL \ DATE
NAME
STREET R/W
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
C
O AD OR ESSFT.
COMP. PLAN ST. R/W FT.
F
U
C CITY TELEPHONE NUMBER
U
Z
REMARKS
I-
Z
C
W
O
U STATE LICENSE NUMBER
CITY LICENSE NUMBER
/ t
/V
CHECKED By
W
Z_
W
STREET AND/OR UTILITY ❑ YES
Z
W
Legal Description of Property (Show Below
or Attach Four Copies)
WORK REQ'D ❑ NO
UNDERGROUND ❑ YES
Z
WIRING REQ'D ❑ NO
O
TYPE CONNECTION VERIFIED BY
F
a
E
N❑
YES PERMIT NUMBER
E
W
W
SEPTIC SYSTEM
3
O
APPVO BY CITY ENG. ElNO
W
N
J
a
REMARKS
/-JA
0
W
J
METER SIZE
SERVICE 512E
CLEARANCE
CHECKED BY
E
W
F
REMARKS
Q
❑ NEW
RESIDENTIAL
❑ LINE
FIRE Z TYPE OF CONSTRUCTION CODE
NON-RESIOENTIAL
❑SIGN
I Qui
❑ AOO ❑
RETAINING
❑ RETAWALL
SPECIREQUIRED SPE CTOR REA
GROUPJOCCUPLOAD OOCACDUPANT
DEMOLISH
❑ ALTER ❑
ORCFILLTE 1[7rj FENCE X—FT)
ES 0
PAN CHEC ED BY THIS SITE
IS LOCATED IN THE CITY
W
It—�rl
PRE -MOVE SWIM
OF EDMONDS. LOCAL SALES TAX
D
REPAIR ❑ OPOOL
INSP.
HOU DBE E
,..ULD
Z
REM RKS
NUMBER OF STORIES
DWELLING I OF NGF '—
'tp`/
J
'-�—
UNITS
m
VALUATION FEE
PROPOSED USE
Z
PLAN CHECH
JJtt''77
0
NO.
/L
y PLOT PLAN INDICATE BUILDING SETBACKS,
ABUTTING STRESTSI
BUILDING
U
W
W
PLUMBING
O
to
HEAT & GAS LINE
O
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
TOTAL AMOUNT DUE
EC— �A . / — Yl
Gtr /�t V rJ
hereby acknowledge that i have read this application; that the In•
on given la correct; and that I nm the owner, or the duly author•
ent of the owner. I agree to eomD1Y with el Ly and &tat e laws ngu•
thereby, no
ATTENTION
APPLICATION APPROVAL
eon.tmeLlOn; end In doing the work authorised person
employed In violation of the Labor Code of the Slate of Washington
THIS PERMIT
This application is not a permit until
to workmen'. Compenaatlon Ina( ence,
r
AUTHORIZES
signed by the Building Official or his Dep-
: Permit Limit One Year (Except DEMOLITIONS whichWORK
ONLY THE
Utyi and fees are paid, and receipt is ac -
completed In Nnety days: MOYED•IN BUILD1N06 .hell be wm-
NOTED
knowledged in space provided.
In six months.)INSPECTION
URE NE O�RAG ENT) DATE SIGNED
DEPARTMENT
OIRECTf1 SI AT E
,.. Z
P-7 s
JEDMONDS
CITY OF
N li: Applicant SuG%ect ti Plan Check ree
GATE —7 �
775.2525
This Permit covers work to be done on private property ONLY.
the domain icurbe, sidewalks, driveways,
ORIGINAL . Filc YELLOW - Insl�cucr
Any construction on public
marquees, etc.( will require separate permission.
PINK . Ovmcr GOLD - !,,ossa