750467.pdfti
BUILDING DEPARTMENT Applicant Fill
=SONE
PERMIT
NUMBER 750467
PERMIT APPLICATION Inside Heavy Lines
JDB
ADDRESS
NAM OR NAME OF BUB ESS
d
l0
•
LEGAL LOT LOT AREA SUBDIVISION NO,
Ir
MAI LIN ADOR ESB
❑YES ❑ NO
`;
1
Z
VARIANCE OR
ADB NO,
)
_...
COND. USE NO.
1
O
CITY ELEPHONE NUMBER
= J
/ 0)
J
PROPOSED YARDS
HEIGHT
Z
Z
FRONT
SIDE REAR
a )
NAME
ALLOWABLE
PROPOSED
J
a _l
F
SIGN AREA
SIGN AREA
U
WADDRESS
I.
OTHER
2
REQUIREMENTS
U
E
CITY TELEPHONE NUMBER
Q
PLANNING DEPT. APPROVAL
DATE
NA -
STREET R/W
EXISTING STREET R/W
FT. DEFICIENCY THIS PROPERTY
E
I-
OGRES
COMP. PLAN ST. R/W
FT. FT.
u
3
O �
E
CITY TELEPHO NUMBER
REMARKS
Z I
_
jj - 3s6�
IJ
I
p
U
ATE CENSE NUMBER CITY LICENSE NUMBER
CHECKED BY
W
Z
Z
Legal Description of Property (Show Below or Attach Four Copies)
STREET AND/OR UTILITY
❑ YES
W
WORK REO'D
❑ NO
UNDERGROUND
❑ YES
I
Z
WIRING REO'D
❑ NO
O
TYPE CONNECTION
VERIFIED BY
..
7
F
a
�
U
PERMIT NUMBER
W 'I
W
SEPTIC SYSTEMi
D
_
APPVD BY CITY ENG.
❑ ND
N
-�
a
REMARKS
i
W
J
METER 512E SERVICE 512E CLEARANCE CHECKED BY
W
REMARKS
4
3
❑GASNEW LIFIRE
❑ jMR..I-..TIAI_
ODE
ZONE TYPEOFCONSTRUCTION CO—
i
NON-RESIDENTIAL ❑ SIGN
NO
❑ ADD RETAINING
DEMOLISH ❑
❑
SPECIAL I NSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP LOAD
yrA LL
EXCAVATE FENCE
❑ ALTER ❑ OR FILL ❑ (�_ X_Fr)
❑ YES ❑ NO
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
F-
0
PRE-MOVE swim
OF EDMONDS. LOCA L SALES TAX
U
REPAIR O POOL
INSP.
HOU BE
Z
i
NUMBER OF STORIES NUMBER OF
REMARKS
O
'J
DWELLING
D
UNITS O
m
NATURE OF WOR BE DONE
CVALUATION
FEE
PROPOSED USE
PLAN CHE(:K
-
Z
O
NO.
6 PLOT PLAN INDICATE BUIL SETBACKS,
I
ABUTTING STREETSI
BUILDING
I
S
U
W
PLUMBING
1
D
in
HEAT & GAB INE
O
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
I have thb that the In-
TOTAL AMOUNT DUE
Q C
I hereby acknowledge that read application;
tormetion given la correct; and that I am the ower, or the duly author-
ized agent or the owner. I ¢gree to .amply with city and Slate law. negu-
thereby, no
ATTENTION
APPLICATION APPROVAL
faun[ wnetNalo¢; and 1¢ doing the work authorized person
will be employed In vlolatkm of the Labor Code of the Stale of WS.hl.gton
THIS PERMIT
This application is not a permit until
,
relating to Workmen's CompensaUo¢ I-urance.
AUTHORIZES
Signed the Building Official or his Dep-
Suty;ign ed by
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
and fees are paid, and receipt is ac-
Shall he completed In Noety dnYS{ MOVED-IN BDINOS .hall be eom-
WORK NOTED
knowledged in space provided.
plated In el. month..)
INSPECTION
''(
SIGNAT E N R A NT) DATE ONE
DEPARTMENT
DIR TO R'S S-117IJAT _
I
CITY OF
! C' L�/`Zl�tici2
EDMONDS
NOTE: Applicant Subject to Plan C Teck Fee
775-2525This
DATE
I
Permit covers work to he done On private property ONLY.
the domain (curbs, sidewalks, drlvewaya,
ORIGINAL • Filc YELLOW - InsMclor
�I
Any construction on public
marquees, etc.) will require separate permission.
PINK . Owner COLD _ Assessor
I
1
7
PERMIT
ZONE
BUILDING DEPART an, Fill
NUMBER
Line'
PERMIT APPLICATIONADDRESS
Y]
JOB
NAMIE-�OR NAME OF BU NIX.S
LEGAL LOT LOT AREA
SUBDIVISION
1,t
_:y
MAILItADDRESS
❑0 YES 0 NO
ZVARIANCE
t
/\'-/ "�
OR ADS
COND. USE NO.
I
NO,
0
_' '.
CITY,
H NE NUMBER
0
Z
PROPOSED YARDS
1HEIGHT
NAME
FRONT SIDE REAR—
Z
I-
ALLOWABLE
SIGN AREA
1PROPOSED
SIGN AREA
U
W
ADDRESS
t
X
OTHER
REQUIREMENTS
U
0:
CITY
NUMBER
rrLZPIIGIIE
PLANNING DEPT APPROVAL DATE
STREET R/W
,EXISTING STREET R/W FT. DEFICIENCY -;I:S PROPERTY
rc
0
ADDRESS"
COMP. PLAN ST. R/W FT. FT.
U
X
CITY
TELEPHONE NUMBER
REMARKS.
Z
U
gi7'Iff 'CENSE NUMBER
CITY LICENSE NVMBER
ICHECKED By
W
Z
Z
Legal Description of Property (Show Below
or Attach Four Copies)
STREET AND/OR UTILITY ❑ YES
WORK REQ'D 13 NO
UNDERGROUND 0 YES
WIRING 0 No
0
�RPID_
TYPE✓VERIFIED BY
U
pj
PERMIT
SEPTIC SYSTEM
NUMBER
W
APIPV D BY CITY E NG.
J
REMARKS
Id
•
Id
METER SIZE
SIZE
N
I
ISERVICE jCL.AR....
REMARKS
0 NEW
RESIDENTIAL
AS
" r j[[:]
LINE
FIRE ZONE TYPE OF CONSTRUCTION
N.-R.5ID..TIA1
❑ C)
SIGN
❑-]
ICODE
I
0 ADD
Ej DEMOLISH ❑ RETAINING
SRPE;'jIRED I A L a N SPECTOR
`VES
REA
10C UPANCY JOCCUPANT
GRUP LOAD
O
❑ ALTERWA LL❑
E] OR FILL ..CA -AT. []( e NCr
X_-)
0 NO
CHECKED By
THIS SITE
—
IS LOCATED IN THE CITY
a.
—
PRE -MOVE
PLAN
OF EDMONDCS6DLEOCAL, SALES TAX
SHOULD 13E D 31 od
0swim
REPAIR POOL
!REMARKS
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS 7
M
NATURE OF WORK TO BE DONE
VALUATION FEE
Z
PROPOSED USE
PLAN CHECK
2
NO.
I"
PLOT PLAN JINDICATE
if
���SACKS.
ABUT�N
BUILDING
U
W
PLUMBING
HEAT & GAS LINE
O
PENCE
SIGN
RETAINING WALL
SWIMMING POOL.
TOTAL AMOUNT DUE
Set he n
I hereby acaoowl.dg. that I he,. read this application; that the in.
f.'emton given is correct; and that I are the owner, or the duty MthW-
lZed agent of the owner. I agree to COMPIY With City and late I&W, MgU-
ATTENTION
Ialing Co work 1a d.l.. the .. M.11.0 th.0111. 00 1....
APPLICATION APPROVAL
will be ..Played In violation of the Labor Cade of the state of Wasbinst..
THIS PERMIT
This application is not a permit until
rOl&tlng to Workmen's Compensation lesUran".
AUTHORIZES
signed by the Building Official or his Dep
-
NOTE: Permit Limit One Year (Except DEMOLITIONS Which
ONLY HE
NOTED
uty; and fees are paid, and receipt is Be
.hall be completed In nicely day.; MOVED -IN BUILDINGS bell be Co.-
WORK
knowledged in space provided.
pleted in six months.)
N SP CTION
INSPECTION
SIGN A7URS (OWNER OR AGENT{ DATE SIGNED
J
DEPARTMENT
] DR'S 5 �[G; T E
CITY OF
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
775-2525
ThisPermit covers work to be done on private property
Any construction on the domain (curbs, sidewalks, driveways,
ORIGINAL- file YELLOW - Impectcr
public
marquees, etc.) will require separate permission.
PINK - Owner GOLD - Assessor