750504.pdf. 1
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l `ii USE /) PERMIT 1
BUILDING DEPARTMiNT Applicant Fill ZONEfIL / NUMBER 750504 1
PERMIT APPLICATION Inside Heavy Lines doB yLT^/�'v
ADDR E55 .L�'/ / I •I C�LA�t-
NAME IOF ME OF BUSINESS) (,� �(/ �jy�, ,
LEGAL LOT OT AREA SUBDIVISION NO.
IEj MAILING DORESB YES [J NO -
Z VARIANCE OR ADB NO.
� GOND. USE -
O CITLEPHONE NUMBER U '�
f PROPOSED YARDS HEIGHT ?
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FRONT SIDE REAR < 1
NAME (S
F SIGN AREAE SIGN AREA a )
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F ADDRESS
OTHER ! '
I REQUIREMENTS
U
E CITY TELEPHONE NUMBER
Q PLANNING D PT. APPR VAL DATE
NAME 0
STREET R/W
[C EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
O ADDRESS
i- COMP. PLAN ST. R/W FT. FT.
U
E CITY TELEPHONE NUMBER REMARKS Z
r E
Z
0
U STATE LICENSE NUMBER CITY LICENSE NUMBER C D BY W
Z
/ r✓ U i
Legal Descripti roparty (Show Below or Attach Four Copies) STREET AND/OR UTILITY El YES W
WORK REQ'O ❑ NO
UNDERGROUND ❑ YES
i
Z WIRING REQ'D ❑ NO
D
F. TYPE CONNECTION VERIFIED BY
a I
K
N ❑ YES PERMIT NUMBER
Bkmi
W SEPTIC SYSTEM 3
U APPVD Y CITY ENG. ❑ NO In '1
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in
� REMARKS
W
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METER SIZE SERVICE SIZE CLEARANCE CHECKED BY �
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REMARKS Q j
❑ NEW RESIDENTIAL L NGAS
E FIRE ZONE TYPE OF CONSTRUCTIO CODE �Q
NO N•R ESIDENTIAL ❑SIGN —//U� / �7�
❑ ADD RETAINING ❑ DEMOLISH ❑WALL
LTREQUIRED GROUP LOAD
�fl SPECIAL INS PECTOR REA OCCUPANNCY/ OCCUPANT
YC 1 AER EXCAVATE FENCE ❑ YES NO :Y �C 1-
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OR FILL ❑ (_ x FTI PLAN CHEC ED Y THIS SITE IS LOCATED IN THE CITY W
PRE -MOVE SWIM OF EDMONDS. LOCAL SALES TAX D j
REPAIR O INSP. ❑ POOL EMAR SHOULD BE CODED 31,04,O i
Z
NUMBER OF STORIES NUMBLER OF '/ } ,/• ) —
OWE LING /� �v `C� ^ (/�L� _5172-_ V✓�(/r
UNITS
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NATURE OF WORK TO BE DONE
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VALUATION FEE
PROPOSED USE
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p PLOT N INDICATE BUILDING SETBACKS.
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m HEAT &GAB LINE !
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RETAINING WALL
SWIMMING POOL
1 hereby aekaowledge that I have read this application: that the 1n- TOTAL AMOUNT DUE
formation given ie correct; and that I a o the owner, or the duly author- �)
laed agent of the owner. I agree to comply with city and stats laws raga• ATTENTION APPLICATION APPROVAL
,.".a construction: and m doingthe work authorized thereby, no person
will be employed In violation of the Labor Code of the Slats of Washington THIS PERMIT
rcleUag to Workmen's Compensation Insurance. 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 CO.- WORK NOTED uty; and fees are paid, and receipt is ac -
plated In etc months.) wledged in space provided. -
INSPECTION
SIGNA RE (OWNER OR AGENT) DATE SIGNED DEPARTMENT
5 NA tRE
f -�7 CITY OF �
EDMONDS
DATE
NOT/s: Applicant Subject to Plan Check Fee 775-2525 �.�..
This Permit covers work to be done on private property ONLY.
Any
a. 1.
on the public domain (curbs, sidewalks, driveways, ORIGINAL • Filc YELL W - Ill;pcnor
marquees, etc.) will require separate permission. PINK - OI+'ner GOLD - A,ssrr
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'eviPERMIT
20NE�. NUMBER
�, BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATI®Id Inside Heavy Lines ,DB
ADDRESS Z7-� ir7%•
NAME (OR NAME OF BUSINESS)
f LEGAL LOT LOT AREA SUBDIVISION NO.
Al ES ❑ NO i I
¢ADB NO.
W \
MAILING ADDRESS _
Z ._.0 VARIANCE OR I
T, i i �I..',) .C�(_..•.i...,`.�.L COND. USE NO. ` W J
0 ELEPHONE NUMBER Z I',
CITY ' HEIGHT
PROPOSED VAR DS Z j
t. �: t'� .;+–Lf.✓,(;T. �J i 2 (i !v FRONT SIDE REAR
Z
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NAME' PROPOSED a
ALLOWABLE SIGN AREA
SIGN AREA t
H
W
W ADDRESS OTHER
F REQUIREMENTS
Z
V TELEPHONE NUMBER
Q CITY PLANNING DEPT. APPROVAL
NAME STREET R/W '
j EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY .�
EO ADDRESS COMP. PLAN ST. R/W FT. FT. !
U
4 REMARKS Z
F CITY TELEPHONE NUMBER K
W
OCHECKED BY Z !
U STATE LICENSE NUMBER CITY LICENSE NUMBER
W
ill _. �. Z
STREET ANO/OR UTILITY ❑ YES r' W
Legal Descriptic lLt7f,Property (Show Below or Attach Four Copies) WORK REq'D ❑ NO i
UNDERGROUND ❑ YES
Z WIRING REQ'D C3 NO
O TYPE CONNECTION VERIFIED BY
6
Ea
U ❑ yEs PERMIT NUMBER W
WSEPTIC SYSTEM W
V APPVD BY CITY ENG. ❑ NO W
I J REMARKS �
Q
W
W
' J METER 512E SERVICE 512E CLEARANCE CHECKED BY K
W
r
REMARKS '2
❑ NEW El RESIDENTIAL GAS
LINE FIRE ZONE TYPE OF CONSTRUCTION CODE .
❑SIGN I -�. t' i.'
NON -R E5IDENTIAL `�'
PANT
E]ADD
❑ DEMOLISH [WP11_tINTNG SPECI REQUIRED SPECTOR AREA GROUP OCCUPANCV ,LOAD
1
I -I EXCAVATE FENCE ❑ YES ,❑"NO �" ! D•
ALTER x FTI PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY W j
❑ OR FILL [ I_ _ D
OF EDMUNDS. LOCAL SALES TAX W
PRE -MOVE SWIM .i:J„�./.r A SHOULD
E Z
[ REPAIR [INa P. [POOL )
REMARIfS O '
NUMBER OF STORIES NUMBER OF
DWELLING i1 i"lw•Ii .� I.'l. I/t ''i O
UNITS
NATURE OF WORK TO BE GONE
VALUATION FEE
PROPOSE/D VSE PLAN CHECK
Z NO.
C FLOT PLAN INDICA B IbDtN GSETBACKS,
ABVTT NG STREETS)
BUILDING '•/J(J
rc L L. C-
N _ -�.-- �/ ^� PLUMBING �
10, HEAT & GAS LINE
\ 1 FENCE
SIGN
1 r RETAINING WALL
/ SWIMMING POOL
do
Ill /:�•/Y GST
TOTAL AMOUNT DUE
I hereby acknowledge that I have reed this apDllcatlon; that the In-
formatton given is orrect; and that I am the owner, or the duly -thor-
1[ed agent of the. ,e,. I .gree to comply with city and stab Iaws -9-- ATTENTION APPLICATION APPROVAL
,.ting ...etruclloa; and 1. doing the work autborlxed thereby, no parson
will be employed In vfolntloa of Na Lebo[ Cods o[ lbs Beale Of Wasblaglon THIS PERMIT This application is not a permit until
[elating to Workmen's Compe... tI.n Insurance. AUTHORIZES Bred by the Building Official or his Dep -
ONLY THE
NOTE: Permit limit One Year (Except DEMOLITIONS which WORK NOTED utyl and fees are paid, and receipt is ac -
.hall be completed In Wbsly days; MOVED -IN BUILDINGS shell be Co.- knowledged in space provided.
pleted In elx nlonlhe.) INSPECTION
SIGNATURE (OWNER OR AGENT) DATE SIGNED DEPARTMENT DIRECTOR'S SIGN ATUR E�
CITY OF
�A-+– EDMONDS ._..._.._
DATE
NOTE: Applicant Subiect to Plan Check !'ee 775-2525
This Permit covers work to be done on private property ONLY. ORIGINAL - File YELLOW . Inspecmr
Any COnstrmarI.. o , the public
require in (curbs,
pedantsslon,driveways, PINK - 0' er COLD - Assrssrr