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770631.pdfr BUILDING DEPARTMENT Applicant Fill Usm fZ PERMIT ZONE _r% NUMBER 770631 JV[ PERMIT APPLICATION Inside Heavy Lines NAME (OR NAME OF BUSINESS) ADDRESS JOB D4.VHPIc 1 �, Vv / OO/ • \ LEGAL LOT LOT AREA SUBDIVISION NO. W alAi ING ADDRESS ❑ VES ❑ NO © etv Prr STREET R/W 0 �/ 1✓ v ! V � 17'(�72 CITY TELEPHONE NUMBER EXIST NG STREET R/W Gc, Fr, DEFICIENCY THIS PROPERTY L��fff/f — tYcD/�G '7 y3 _ j&/ COMP. PLAN ST. R/W 60 FT, Q Fr. v NAME ^ • REMARKS 19 Z F ADDRESS W U U y/ 0 CK%FFG LF� C C ED Y W Z C Q CITY TELEPHONE NUMBER STREET p AND/OR UTILITY WORK R/W PERMIT REQUIRED l7 Z r _ 'AM ❑ YES 1I��11.. ENO ❑ YES ya NO W E UNDERGROUND t^ r /•— WIRING REQ'D. ❑ YES f9N0 0 ADDRESS TYPE CONNECTION *YES VERIFIE BY U Q SANITARY SEWER ❑ / F 1 CITY TELEPHONE NUMBER SEPTIC SYSTEM NO ❑ YES PER T NUMBER Z APPV•D BY CITY ENG. 0 '@11NO U STATE LICENSE NUMBER CITY LICENSE NUMBER REMARKS Legal Description/of Property (Show Bellow or Attach Four Copies) METER SIZE BUILDING SUPPLY SIZE REMARKS W ►- Z o �"XcSZi►J c� 3 1= 6 SIGN AREA ENV, REVIEW qpB NO, H ALLOWED OPOSED COMPLETE EXEMPT W 0 ( J � tiEMAR1C5 W J VARIANCE OR CU PLANNIN EVI BY DATE YARDS I ^/ LOT COVER E _`� FRONT {SIDE L� ® ❑ NEW RESIDENTIAL ❑ GAB REAR ❑ LINE ❑ SIGN FIRE=�y� TYPE OF CONSTRUCTION co -�'y/j' i ® ADD / �� DEMOLISH RETAINON-RESIDENTIAL ❑ WALL NING ALTER EXCAVATE R� REQUIRED SPECTOR A/ q I OCCUPANCY OCCUPANT GROUP Lpgp FENCE ❑ OR FILL ❑ ( XSITE—FS ❑ YES ❑ NO S/C) _Fi) ❑ REPAIR PRE -MOVE swim ❑ PLAN CHECKE BY �IN THE CITY THISEDMONDS.00ATED LOCAL INSP, ❑ POOL SALES TAX SHOULD BE CODED 31,04, NUMBER OF STORIES NUMBER OF i4 DWELLING UNITS f^- Z NATURE OF WORK TO BE DONE / it W 1 ADDN Z 0(4 E. E f lie lcc Q 6 W Z PROPOSED USE VALUATION FEE A 0 ✓/�� [ / I/ /V— PLAN CHECK NO. G tl Z 6 PLOT PLAN INDICATE BUILDING SETBACKS, W U ABUTTING STREETS) BUILDING /, ♦-�1 y (1 0 S/ 0 e y H 1 / ✓ •• ' 0 W PLUMBING J ; o s•a' e � CXIs(, HEAT at GAS LINE W o I -^�--- R(�:51%�,J,` FENCE g SIGN Z - �- RETAINING WALL f ." SWIMMING POOL 0 U 17ECIC-93,65—ROAD 0LYHfhL Vl�zv �f�iUc I hereby acknowledge that I have read this application; that the in. TOTAL AMOUNT DUE 6 0 formation 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 regu- lating construction; and in doing the work authorized thereby, no person ATTENTION APPLICATION APPROVAL will be employed In violation of the Labor Code of the State of Washington rclatirl to Workmen's Compensation Insurance. THIS PERMIT This application is not a permit NOT Permit Limit One Year(Except DEMOLITIONS and FILL AUTHORIZES until signed by the Building Official or PERMITS without conditional use permit, which shall be completed in 90 ONLY THE his Deputy; and fees are paid, and p y' days; MOVED -IN BUILDINGS shall be completed in six months.) WORK NOTED receipt is acknowledged in space pro- SIGNATURE (OWfjoER OR A T DATE SIGNED INSPECTION Ylded. DEPARTMENT R ORS SIGNATU E CITY OF t NOTE: Applicant Subject to Plan Check Fee EDMONDS DATE 775-2525 This Permit covers work to be done on private property ONLY. Any construction on the public domain (curbs, sidewalks. drlve ws IP_ _ marquees, otc,l Will require separate permission. _...—....,� - I ,,., ,,, Wvv - �nspncror COLD Asuscsnr PINK J a _ r