820030.pdfU Sew_�u��` P E R M I, O'n P%
f ZONE
NUMBER
CITY OF EDMOND=.� .j
BUILDING PERMIT APPLICATION JOB Id
NAME (OR NAME OF BUSINESS) ADDRESS 16411 75th Place West
LEGAL DECR SIPTION SUBDIVISION SHORT
Donald Hansen SUB NO.
-a W MAILING ADDRESS f'
2
3
16411 75th Place el, PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
0 CITY TELEPHONE NUMBER
EXISTING
Edmonds 743-3695 Z
-- --- -- PROPOSED W 1 i
NAME. -- W
DEFICIENCY OF RIGHT OF WAY z, { 1
F 1
U__--_______._--___.________.__-- CHECKED BY 0
W ADDRESS Z
f• SEE ENGINEERING MEMO DATED W
C CITY TELEPHONE NUMBER REMARKS r!i
Q — — Renewal of 750444 and 770063
NAME
Owner — __--.—_—__--..----- METER SIZE I BUILOINL G SUPPY SIZE FIXTURE UNITS t
0 ADDRESS
W )
U
Q -- RKi
REh1A
I CITY TELEPHONE NUMBER'
I-
z
0 ADB NO.
U SIGN AREA ENV. REV ILK'
STATE LICENSE NUMBER CITY LICENSE NUMBER
AI -LOWED PROPOSED COMPLETE EXEMPT
SHOR
Legal Description of Property (Show Below or Attach Four Copies)
�. VARIANCE OR CU PLANNING REVIEW BY PATE I 1
Z !— s
O; LOT COVERAGE �10
UIYARDS
-RONT SIDE REARI �Q
REMARKS
a
o Renewal of 750444 and 770063 a
a --
NEW I r•�,• RESIO EN TIAL ❑ PLUMBING !{
CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
El
NON-RESIDENTIAL ❑MECHANICAL V — N 1973 __ I.
JAI ADD ❑
SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
DEMOLISH ❑SIGN REQUIRED GROUP LOAD
❑ ALTER EXCAVATE FENCE _'YES NO I L
❑ OR FILL ❑ I_ X FT) REMARKS Z _
Renewal of 750444 and 770063 0
❑ REPAIR ❑ PRE -MOVE INSP.j ❑S\VIM J
COMPLIANCE INSP. POOL
Z NUMBER OF STORIES NUMBER OF }/� {�C`��'��
an.
0 DWELLING
`r 1
UNITS
d NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN) 9
U
Add Bedroom and Study '
t.
0
Renewal of 750444 and 770063 PLAN CHECK FEE
0 VALUATION FEE t
?
?
BUILDING Renewal. 5.00
PLUMBING
I )
MECHANICAL. r
,
This Permit covers work to be done on private property ONLY. ---�—
Any construction on the public domain (curbs, sidewalks, driveways, FENCE _
marquees, etc.) will require separate permission. I i
SIGN
Permit Application: 180 Days
Permit Limit: 1 Year -Provided Work Is Started Within 120 Days RETAINING WALL
C9 "Appli,an:, on I,ehaL , : ills,_ : her a eu>e, !tr >..n,i_a:.uld
SWIMMING POOL I L
at:ccs>:+rs in intrr:',: '.0 1+, tndt� lii}'.,irtenJ _,nd 11+Ia
i IIIQ C \ ol I II ni , tC I i "t+l • i1ci11>, rmp!t'}rc,. .nd
C .l,i �+ +, d.al,.�'e, 4+I :`IL1;P:Ct n.It❑tc, I
x m ? uI e \ n I I_.LIR hi 1 n. t;ac- I 5,00
{ +-rc, +,I :u tedu;e TOTAL AMOUNT DUE 1
0 lI'.CC n aiU ?•t I +I' :I '.li Rt b d: 7 .+' t' I•�. '
I Crl}- - ,t•illt\ 1 11. ._ 11- :dul 1 )_: ,;ir+I. ATTENTION I APPLICATION APPROVAL -"
?r I 1 e e ad :n 1{ ; Ii :i ,n; :llet 01c In-
( herCl IC'KIlPuit it perllllt
I OLRld ilO❑ LI t'Il h t a THIS PERMIT Ihi$ application I$ Ill)I a
i ' + l punt }u dill, suthor- ) }
i7ed accn+ lu lent I sz c i ,u; y I\ cl+h I \ Ind ;.ail lea's RIu-
Aurr+oRlzEs I until signed by the Building Official or
vn, :I e u: ,; .:_thoriled :nereb}, n., ncri+rt ONLY THE his OClrilt�'; ;llld fees arc )l:ild, iltld
R"I?I be CRiI71+.Ced I7t tld�!1h+:1 JS t}te Labor CJdr Oi :i121::{:e O1 a;111❑[AAt '.PORK NOTED receipt 1s acknowledged Ill space �lr(1• l
1
SBt:Ill11 �` lil I�OI?�tI1Cn•; �+'ml+eq5-tlli`it IR,L: �I: Y. Vidt•d. ,
INSPECTION
SI NATURE (OWNER OR DATE SIGNED GENT) OEPA RThtENT DIRF}.*�'OR'S SIGNATURE
CITY OF
EDMONDS 6AT
THIS SITE IS LOCATED IN THE CITY 775-2525
OF EDMONDS. LOCAL SALES TAX 0
SHOULD BE CODED 31.04,
ORIGINAL -- File IYELLOW -- Inspector
ATTENTION
17 IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE PINK - Ovmer GOLD — Assessor
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR f
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 304, 306.
t ez-�s