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PERMIT740124
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PERMIT APPLICATION Inside xmvy
ADDRESS
NAME
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ACTUAL
I.OT COVESYAOE
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LOT COVERAOEe
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ACTUAL LOT AREA
TOTAL BLDG. A}tEA i
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FRONT SIDE HEAR FItONT 915E REAR
NAME
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LICA I C
LEGAL LOT ARIANCF. Olt CONDITIONAL USE
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al
ADDRESS
0 YES NO PERMIT
NUMBER 1
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PLANNING DEPT, APPROVAL DATE:
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1
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STREET it/W
EXISTING STREET R/W-...........F7'.
DEFICIENCY TIIIB PROPERTY
NAME
COMP. PLAN ST. R/W ............IT.
............FT.
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REMARKS
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ADDRESs
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CHECKED BY
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METER SIZESERVICE SIZE
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STATE LICENBID NUafDER
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-REMARKS
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Legal Description of Properly (Show Below/�orr --e. Copies)
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SPECIAL INSPECTOR REQUIRED
OCCUPANCY
GROUP
❑ YES Qa�NO
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IN THE CITY
AS
❑ RESIDENTIAL ❑ LINE
❑ NEW
PLAN CHECKED
THIS SITE IS LOCATED
LOCAL SALES TAX
NON-RESIDENTIAL
❑ F-1 SIGN
OF EDMONDS.
SHOl1LD eE CODED 31 04
❑ ADD �r—{,�trTAININO
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REMARKS
DEMOLISHL_1
FENCE
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❑ ALTER ❑ EXCAVATE
OR FILL ❑ (.........3..........Ft.)
SWIM
❑ REPAIR ❑ NP. POOL
NUMBER OF STORIES NUMBER 08
D W ELLINO
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UNIT°
NATURE OF WORK TO BE DONE
Valuation
Fee Receipt No.
Plan Check No .....................
Z
BUILDING
PROPOSED VSE
PLUMHIN6
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BEAT & GAS LINE
aPLOT
PLAN (Indicate Building setbacks, abutting streets)
O
FENCE
SIGN
RETAINING WALL
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N
SWIMMING POOL
DEMOLITION
'
PRE -MOVE INSPECTION
EXCAVATION OR FILL
3 O(7 9707
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this applicalioo: that the I.-
formationm given is correct; and that I athe owner, or the duty author-
Ired agent of the owner. I agree to comply with city and state I— "go-
ATTENTION
APPLICATION APPROVAL
lating construction; and to doing the work authorlud thereby, no person
will be employed In violation of the Labor Code of tha state of Washington
THIS PERMIT
This application Is not a permit until
relating to Workmen'$ Compensation Imuesub".
AUTHORIZE"
signed by the Building Official or his Dep -
NOTE: Permit limit One Year (Except DEMOLITIONS whlch
ONLY THE
WOHR NOTED
uty; and fees are paid, and receipt is ac
.hall be completed In eloely day.: MOVED -JN DUILDINGS shall be win-
Imowledged In dace provided.
p/!shed/ In six m..the.)
et-6yti7'URE (OWNER OR ADEN )
ATE SIGNED
INSPECTION
IR '8 !° NAT URE
RTMEN
DEPARTMENT
`
/
CITY OF
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
PH g-1107
This Permit coven work to be done on, Private property ONLY.
Any caa.troctlon M the public domain (curb., sidewalks, driveways,
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marquees, eta.) will require separate perailasloa.
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BUILDING DEPARTMENT AppLLcant FILL ONE • ' `1 NUMBIER 7 `�
--- PERMIT APPLICATION Inside x°avy LweB
NAME (OR NAME OF BUBINEBB)
MAILING ADDRESS
CITY - P ON BER
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y NAME
IOd
ADDRESS(•
ADDRESS :• /..�
lrj r7) ('J
PFRMISSIBLE ^
LOT COVERAGES
ACTUAL
LOT COVZRAGE
PERMISSIBLE HEIGHT
PROPOSED HEIGHT
ACT At, LOT AREA
TOTAL BLDG. AREA
REQUIRED YARDS PROPOSED YARDS
FRONT SIDE REAL( FRONT SIDE REAR
PLAN CHECKED BY
THIS SITE I5 LOCATED IN THE CITY
LEGAL LOT
YES NO
VARIANCE OR CONDITIONAL USE
PERMIT NUMBER
S
W
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STREET It/{V
FE�
CITY
EXISTING STREET R/W .......... ..Fr.
DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............Fr.
__. ............FT.
REMARKS
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PLAN CHECKED BY
THIS SITE I5 LOCATED IN THE CITY
CIIEC11ED BY
PLOT PLAN (Indicate Building speats)
'I
Legal Description of Property (Show Below or Attach Four Cople
METER SIZE
I SERVICE SIZE CLEARANCE
OfIRCKED BY
ADD
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RETAINING
I
REMARKS
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VERIFIED BY.
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PERO. T
T NUDSBER
REMARKS
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PLANNING DEPT. APPROVAL DATE:
CITY I TELEPHONE NUMBEri
N ADDRESS
RESIDENTIAL
FE�
CITY
[j YES 0 N
TELEPHONE NUME
Z
NEW
U
PLAN CHECKED BY
THIS SITE I5 LOCATED IN THE CITY
STATE LICENSE NUMBER
PLOT PLAN (Indicate Building speats)
CIT LICENSE NUI
Legal Description of Property (Show Below or Attach Four Cople
\rUjilgS
OF EDMONDS. LOCAL SALES TAX
ADD
FENCE
RETAINING
F:
SHOULD BE CODED 3104.
Y
U
n
D'WALL
W
tl
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V
F-1ALTER
ALTER
J
FENCE
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FIRE ZONE TYPE OF CONSTRUCTION R E IDSPROVED
EI -YES ONO
SPECIAL INSPECTOR REQUIREDOCCUPANCY GROUP
LJOR FILL
RESIDENTIAL
6A8
O LINE
[j YES 0 N
—1 -
NEW
UNITS
PLAN CHECKED BY
THIS SITE I5 LOCATED IN THE CITY
PLOT PLAN (Indicate Building speats)
NON.RESIDENTIAL
❑ SIGN
\rUjilgS
OF EDMONDS. LOCAL SALES TAX
ADD
FENCE
RETAINING
REMARKS
SHOULD BE CODED 3104.
DEMOLISH
D'WALL
N
[i ;i✓
F-1ALTER
ALTER
EXCAVATE
FENCE
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,"; '�..' i� • �,./G' '� `� iv'
LJOR FILL
LJ (........_x .......... Ft.)
PRE -MOVE
FJ REPAIR ❑ INSP.
owl
POOL
LUMBER OF STORIES NUMBER OF
DWELLING
UNITS
PATURE OF WORK TO BEDONE
PLOT PLAN (Indicate Building speats)
HEAT & OAB LINE
Valuation
1
No.
/
Z
Plan Check No .....................
BUILDING
PROPOSED UBE
PLUMBING
PLOT PLAN (Indicate Building speats)
HEAT & OAB LINE
\rUjilgS
O
FENCE
SIGN
RETAINING WALL
/
N
[i ;i✓
ySWIMMING
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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I hereby acknowledge that I have read talo application; that the In-
I 6')
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 .tate laws Milo-
ATTENTION
APPLICATION APPROVAL
laung construction; and In doing the work authorized thereby, no person
will be employed In Vlolallon of the Labor Code of the State of Washington
TIU8 PERMIT
This application is not a permit until
retaling to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
uty; and fees are paid, and receipt is ac -
shall be completed In ninety days; MOVED -IN BUILDINGS shall be Co.-
knowledged In space provided.
pitted In elx mouth,.)
SIGNATURE (OWNER OR A.EN DATE SIGNED
INSPECTION
DEPARTMENT
DIR CT R'B'BIGNATURE
; -
�)
CITY OF
� ' i/�. .(. •
•1
EDIIIONDB
DATE � r
NOTE: Applicant Subject to Plan Check Fee
Pit 114107
This Permit coven work to he done on private property ONLY.
Any Construction on the public domain (etubs, sidewalk., driveways,
INSPECTOR
marquee., Ste.) will regmre separate perndssion.
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RECORD OF INSPECTIONS
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Date_ Passed '
Foundation
.Plumbing (Partial) ---- ,,.
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(Rough) ---- E
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Frame ----
Furnace &Fuel lines_---- s
Final 7--- 7 �J
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