750457.pdfo Hospital
a
U
U
D
or Minh Four Copies) STREET AND/OR UTILITY
WORK REWD ❑ NO
UNDERGROUND ❑ YES
WIRING REQ'D ❑ NO
750457
, ......
METER\SIZE( SE RYICE sr.
ATTENTION
SUBDIVISION NO,
ADB NO.
This application is not a permit until
BUILDING DEPARTMENT Applicant Fill
us
ZONE NF
HEIGHT
PERMIT APPLICATION inside Heavy Lines
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Q LINE
FIRE Z E TYPE OF
s
ADDRESS
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NAME IDR NAME OF BUSINESS)
CIV YJL/
DATE
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® ALTER ❑ ORCFI LLTE
LEGAL LOT LOT ARI
FT.
❑ REPAIR ❑'NSPM OVE
Stevens Memorial Hospital
❑ YES ❑ NO
ORIGINAL - File YELLOW - Inspector
E
W
MAILING ADDRE55
CHECKED BY
2 - sinks
UNITS
Z
VARIANCE OR
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W
O
YY
21600 76th West
GOND. USE NO.
1 - washer rou h
PROPOSED USE
CITY
TELEPHONE NUMBER
Z
O
NO.
y PLOT PLAN INDICATE BUILDING SETBACKS,
0
PROPOSED YARDS
BUILDING
Edmonds VIA
6— 1
FRONT SIDE
O
NAME
0
HEAT & GAS LINE
ALLOWABLE 1
F
SIGN AREA
U
W
F
ADDRESS
OTHER
=
REQUIREMENTS
SWIMMING POOL
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lC
CITY
TELEPHONE NUMBER
PLANNING DEPT. APPROVAL
NAME
STREET R/W
Dell E Peterson Plumbing& Heatin Ince
EXISTING STREET R/W F
E
O ADDRESS
COMP. PLAN ST. R/W F
10 2 Aurora Avenue North
a
F CITY
TELEPHONE NUMBER
REMARKS
Z Seattle WA
U cru.. LIC.NSE NUMBER
52h-1631
CITY LICENSE NUMBER
o Hospital
a
U
U
D
or Minh Four Copies) STREET AND/OR UTILITY
WORK REWD ❑ NO
UNDERGROUND ❑ YES
WIRING REQ'D ❑ NO
750457
I
A
METER\SIZE( SE RYICE sr.
ATTENTION
SUBDIVISION NO,
ADB NO.
This application is not a permit until
D
Z
Z
REMARKS
HEIGHT
REAR
❑ NEW RESIDE�.T.
Q LINE
FIRE Z E TYPE OF
❑ NO N•R
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ED
eEA
❑ ... ❑ DEMOLISH
DATE
7R
1 1
® ALTER ❑ ORCFI LLTE
ICIENCY THIS PROPERTY
FT.
❑ REPAIR ❑'NSPM OVE
❑pOOL
W
ORIGINAL - File YELLOW - Inspector
W
W '
NUMBER OF STORIES NUMBER OF
DWELLING
CHECKED BY
2 - sinks
UNITS
Z_
NATURE OF WORK TO BE DONE
O
W
❑ YES
TYPE CONNECTION VERIFIED BY
IS T1►j
❑ YES PERMIT NUMBER W
SEPTIC SYSTEM
APPVD BY CITY ENG. ❑ NO
ut
i
i
LEARANCE CHECKED BY
E
W '
3
ICTION CODE
I hereby aeknowletlge that I hnve read this application; that the In-
formation given Is correct; and that I nm the owne duty wlhIn
fzed agent or the owner. I agree to comply with ciab lawn regu-
lating conntractlon; and In doing the work authoreby, no person
will be employed In violation Of the Labor Cade of of Wubingtonrelating to Workmen's Compensation Insurmce.
NOTE: Permit limit One Year (EaceplITIONS which$hall be completed In ninety days; DIOVED•IN BUshall be com.pleted in six months.)
TOWSIGNED%1 =7�
NOTE: 4pk4icant Subject to Plan Check Pee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
THIS SITE IS LOCATED IN THE CITY G
OF EDMONDS. LOCAL SALES TAX
SHOULD BE COPE12O
0
2 - water closets
7
m
-in Total cost: $11.00
VALUATION FEE
I l aaa
AL AMOUNT DUE
,APPROVAL
METER\SIZE( SE RYICE sr.
ATTENTION
APPLICATION
E 1 1
This application is not a permit until
'
REMARKS
elgned by the Building Official or his Dep -
❑ NEW RESIDE�.T.
Q LINE
FIRE Z E TYPE OF
❑ NO N•R
❑ SIGN
❑ ... ❑ DEMOLISH
F-1RET AINING
SPECIAL
REQUIRED SPE CTOR RE.
® ALTER ❑ ORCFI LLTE
WALL
1 ENCS X_FT)
❑
ES No
C3 AN CHECKED BY
❑ REPAIR ❑'NSPM OVE
❑pOOL
ORIGINAL - File YELLOW - Inspector
REMARKS
NUMBER OF STORIES NUMBER OF
DWELLING
PINK - Owner GOLD - A,s carr
2 - sinks
UNITS
NATURE OF WORK TO BE DONE
1 - service sink
1 - washer rou h
PROPOSED USE
PLAN CHECK
Z
O
NO.
y PLOT PLAN INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
BUILDING
WPLUMBING
O
0
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
I hereby aeknowletlge that I hnve read this application; that the In-
formation given Is correct; and that I nm the owne duty wlhIn
fzed agent or the owner. I agree to comply with ciab lawn regu-
lating conntractlon; and In doing the work authoreby, no person
will be employed In violation Of the Labor Cade of of Wubingtonrelating to Workmen's Compensation Insurmce.
NOTE: Permit limit One Year (EaceplITIONS which$hall be completed In ninety days; DIOVED•IN BUshall be com.pleted in six months.)
TOWSIGNED%1 =7�
NOTE: 4pk4icant Subject to Plan Check Pee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
THIS SITE IS LOCATED IN THE CITY G
OF EDMONDS. LOCAL SALES TAX
SHOULD BE COPE12O
0
2 - water closets
7
m
-in Total cost: $11.00
VALUATION FEE
I l aaa
AL AMOUNT DUE
,APPROVAL
ATTENTION
APPLICATION
THIS PERMIT
This application is not a permit until
'
AUTHORIZES
ONLY THE
elgned by the Building Official or his Dep -
WORK NOTED
uty; and fees are paid, and receipt is Be
;
Ilnowledged in space provided.
INSPECTION
DEPARTMENT DIRE
CITY OFFi�yt,
R•S SI
EDMONDS
---
775-2525
ORIGINAL - File YELLOW - Inspector
PINK - Owner GOLD - A,s carr
t`y
ti
USE
PERMIT
1
BUILDING DEPARTMENT
Applicant Fin
=°"E
NUMBER
PERMIT APPLICATION
Inside Heavy Lines
jou
AODFE55l - � •� '- I I) {
NAME (OR NAME OF BUSINESS)
.�._-('`'u4
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1
LEGAL LOT LOT
AREA SUBDIVISION NO.
1
:�. ,,,-....r O.,n,•.) ., '. 7
❑YES ❑ NO
if
1
MAILING ADDRESS
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=
VARIANCE OR
ADB NO.
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GOND. USE NO,
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CITY
ELEPH ONE NUMBER
HEIGHT
Z
PROPOSED YARDS
Z
FRONT
SIDE REAR
Z -
NAME
ALLOWABLE
•Il
a
f-
SIGN AREA
SIGN AREA
U
W
ADDRESS
F
OTHER
;
=
REQUIREMENTS
+
IfCITY
ELEPHONE NUMBER
PLANNING DEPT. APPROVAL DATE
I
C
1F` %
NAME
STREETfl/W
�',J,r''11;!JI': i.l:l't. '' '�l.:'.� f-'
EXISTING STREET R/W
FT. DEFICIENCY THIS PROPERTY
nl _r
OADDRESS' - i
COMP. PLAN ST. R(W
'FT. FT.
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u JF'
It -
REMARKS
l7
=
It CITY TELEPHONE NUMBER
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CHECKED BY
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U STATE LIC NSE NUMBER
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CITY LICENSE NVMBER
Z
YES
w
Description of Property (show Below
or Attach Four CGPles)
STREET AND/OR UTILITY
Legal
WORK REWD
❑ NO
UNDERGROUND
❑ YES
1
WIRING REQ'D
❑ NO
Z
TYPE CONNECTION
VERIFIED BY
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or
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SE To �+, CITM I
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REMARKS
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METER SIZE
SERVICE SIZE CLEARANCE
CHECKED
BY
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REMARKS
T�
❑ NEW RESIDENTIALLINE AS
SIGN
❑
FIR EIZONE TYPE OF CONSTRUCTION CODE
1111-
NON-RESIDENTIAL ❑
OCCUPANT
❑ ADD
RETAINING
❑
SPECIAL INSPECTOR AREA
REQUIRED
OCCUPANCY
GROUP LOA°
/
DEMOLISH WALL
❑ YES ❑ NO
4-11',.'��.Y��ll i",'-�
y
EXCAVATE FENCE
ALTER ❑ OR FILL 1_ X—FTI
PLAN CHECKED By
THIS SITE IS LOCATED IN THE CITY
w
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OF EDMUNDS. LOCAL SALES TAX
❑ ❑ PRE -MOVE SWIM
REPAIR POOL
$HOU D E E
D
Z
INSP.
REMARKS
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NUMBER OF STORIES NUMBER OF
J
-
DWELLING
UNITS
in
NATURE OF WORK TO BE DONE
r"
VALUATION FEE
Z
PROPOSED USE '. _
PLAN CHECK
NO.
j
y
ILOIG ETBAC KSS
PLOT PLAN INDIC1tTE-BUIL-01
ABUTTING STREETS)
BUILDING
�•-
yUi
PLUMBING
W
O
m
HEAT &GAS LINE
O
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
TOTAL AMOUNT DUE
!1 '1 0
I hereby acknowledge that I have read this application; that the In.
V -
,
lormatlon 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 state laws ratio' ATTENTION
APPLICATION APPROVAL
Idling construction; and In doing the work authorised thereby no person
will be employed In violation Or the Labor Code Of the Beate of WYhWtitOR
THIS PERMIT
This application is not a permit until
relnliog to Workmen's Compenealita IYuranee.
AUTHORIZES
signed by the Building Official or his Dep
-
NOTE: Permit Limit One Year (Except DEsto-TION8 whish ONLY THE
NOTED
uty; and fees are paid, and receipt is Be
-
,hall be Completed In nlpety days; BIOVED-IN BUILDINGS shall be Cam- WORK
knowledged in apace provide.
pleted In elx month,,)
INSPECTION
DEPARTMENT
_
DI 'S 51
.
SIGNATURE (OWNER OR AGENT) DATE SIGNED
1 - ;i -• --�a.l
CITY OF
EDMONDS
DATE _-
NOTE: Applicant Subject tO Plan Clieck Fee
775-2525
This Permit covers work to be done on private property ONLY.
driveways,
ORIGINAL -file YELLOW - 1-pec
Any construction on the public domain (curbs, sidewalks,
PINK -Owner GOLD • Assesses
marquees, etc.) will require separate permission.
j
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