750488.pdfr .
USE PERMITI
BUILDING DEPARTMENT Applicant Fill ZONE NUMBER 750488
PERMIT APPLICATION Inside Heavy Lines
NAME IOR NAME nOF BUSINESS)
E N
W MAILING A D ESS
Z t
3 y
O 1 Y ELEPMON/E NUMBER
19R e
Z
NAME Z
Z
Q
U y
F ADDRESS
i
U
a: CITY TELEPHONE NUMBER
Q
NAME
E
0 DRESS
F
V
e:
I.' CITY TELEPHONE NUMBER 0
Z Z iI
O
U STATE LICENSE NUMBER CITY LICENSE NUMBER W II
W
Z
Legal Description of Property (Show Rein- or Attach Four Copies) w.�
�—
Z `
j I i
O
a_
E
U 1,
N
W
O
J
S REMARKS W
W
W
J II 1
METER SIZE SERVICE SIZE CLEARANCE CH ECKEO BV
ul
REMARKS"/I < I
❑ NEW ® RESIDENTIAL E] llvl
LINE FIR lsr 3
TYPE OF CONSTRUCTIO CODE ,t� 1
NON-RESIDENTIAL j[:]SIGN T t I,6C i1/rr 3 f
❑ ADO ❑ DEMOLISH ,�('� (N lla��/// :/r �,/ /J
RETAINING SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
WALL REQUIRED GROUP LOAD
® ALTER ❑ EXCAVATE FENCE ❑ YES M_INO ,�
OR FILL (_ x_FT) PLAN CN EC D BY THIS SITE IS LOCATED IN THE CITlid
Y a
REPAIR Ej PRE -MOVE SWIM OF EDMONDS. LOCAL SALES TAX a I -
INSP, O POOL SHOULD RE U '
EMA KS Z
NVMBER OF STORIES NUMBER OF
DWELLING I 0
UNITS J
NATURE OF WORK TO BE GONE m
PROPOSED USE VALUATION FEE
Z l PLAN CHECK
O r NO.
6 PLOT PLAN INDICATE BUILDING SETBACKS,
ABUTTING STREETS) BUILDING U O�� _
Id f a ch ed .sa
PLUMBING
O HEAT & GAS LINE
I
FENCE
SIGN
RETAINING WALL
SWIMMING POOL ,
I hereby acknowledge that I have read this application; that the In. TOTAL AMOUNT DUE So
formation given Is correct; and that I am the owner, or the duly author- �^
Iced agent of the owner. I agree to comply with city and state laws regu-
lating "riat"'IOa; and m doing the work allthorind thereby, no person ATTENTION APPLICATION APPROVAL
will be employed in violation of the Labor Code of the slats of Washington
relating to Workmen's Compensation Insurance. THIS PERMIT
AUTHORIZES This application is not a permit until
NOTE: Permit Limit One Year (Except DEMOLITIONS which ONLY THE signed by the Building Official or his Dep.
.hall be completed In ninety days; MOVED -IN BUILDINGS shall be cem- WORK NOTED cetyl and fees are paid, and receipt 1s ac-
pleted In .Ix menthe.) knowledged in apace provided.
SIGNATURE (OWNER OR AGENT) DATE SIGNE� INSPECTION
1 DEPARTMENT D EG GNA VR
�'/ �j CITY D j
EDMUNDS
DATE
NOTE: Applicant Subject to Plan Check Fee I
775-2525 , _ 7 ,)
This Permit covers work public be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, ORIGINAL. File YELLOW - h,speclor
marquees, etc.) Will require separate permissiOn, god PINK - n+•.� , GOLD - 1.
.IDB �
ADDRESS
LEGAL LOT LOT AR SUBDIVISION NO,
❑ YES ❑ NO
VARIANCE OR ADB NO.
GOND, USE NO,
PROPOSED YARDS HEIGHT
FRONT SIDE REAR
ALLOWABLE PROPOSED
SIGN AREA SIGN AREA
OTHER
REQUIREMENTS
PLANNIAN_G DEPT. APPROVAL GATE
STREET R/W
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W FT. FT.
REMARKS
CHECKED BY
STREET AND/OR UTILITY El
W
;
W
WORK REO'D ❑ NO ,
UNDERGROUND ❑YES
WIRING REq'D ❑ NO
TYPE CONNECTION VERIFIED BY
SEPTIC SYSTEM ❑ YES PERMIT
NUMBER
APPVD BY CITY ENG. ❑ NO
,mss ,2vi J i�ie�y,;
0-/;" e, 3.rq9„
1 �a
is
0 v/� /Gt w�
�i�GiGt7�!, U /G . ,�/!!•:O �l!.pit'�i.._ .c3r/f dl�.'. 1 z rye
-7-;n A �8
�''� ' V?•.� J,.,. 11 JJ'•'- ��1Pi•• ,.`� ,�• �h, �� �'i!. ;'� lJrir'_._—__
1'J•l� 1LwJ.:l�.1 • w...Y . i P ,'!' J w'1. • - .`ry .-)"r9t 16 r-�'19 _.�•/-- .� .
'LLAS .i Iq
1 .�: .. ... ._. .._....._ __ .. .. ... .... ._
1
0 4
,mss ,2vi J i�ie�y,;
0-/;" e, 3.rq9„
1 �a
is
0 v/� /Gt w�
�i�GiGt7�!, U /G . ,�/!!•:O �l!.pit'�i.._ .c3r/f dl�.'. 1 z rye
-7-;n A �8
�''� ' V?•.� J,.,. 11 JJ'•'- ��1Pi•• ,.`� ,�• �h, �� �'i!. ;'� lJrir'_._—__
1'J•l� 1LwJ.:l�.1 • w...Y . i P ,'!' J w'1. • - .`ry .-)"r9t 16 r-�'19 _.�•/-- .� .
'LLAS .i Iq
1 .�: .. ... ._. .._....._ __ .. .. ... .... ._
1