750194.pdf• + UBE PERMIT 1n'1914
` BUILDING DEPARTMENT Applicant Fill '
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-- PERMIT APPLICATION Inside Heavy Lino. J013
ADDRESS /I%O bet 1
NAME (OR NAME OF BUSINESS) 7 0 / �^'WG•e•• W j
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T COVERAGF�� / LOT COVERAGE
td fA O I wt ADDRESS ✓ / ;J t'
[d �^ PERMISSIBLE HEf611T �7 1 YKOYOBED lIEIOHT '
C CITY TELE ONE NUMBER ACT AL LO'r AgE 'I� A - y
PROPOSED YARDS
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REQUIRED YARD"
NAME
FRONT HIDE REAR FRONT "IDE REAR
LOT V IIIA NCF: OR D NAL 1
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ADDRESS
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Y 8 ❑ O P MIT NUM
PLA N DEP T. PYR L AT
to CITY
TELEPHONE NUMBER
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STREET BIT',,
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NAME
EXISTING STREET R/- DEFICIENCY THIS PROPERTY
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COMP. PLAN BT. R/W .:; ... `ASSET. (d
REMARKS to those
Driveway slopes not exceed
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indicated on Standard Dwg. No. 103 w
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TELE ONE NUMBER
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METER SIZE BER VICE "" CLEARANCE
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STATE LIC SE NU BER
CITY LICENSE NUMBER
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Legal Description of Property (Show Hclaw or Attach Four Copies)
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TYPE CONNECTION
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PERC. TEST
PERMIT
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REMARKS
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FIRE ZON TYPE OF CO ION STREET IMPROVED
r E. ❑ NO
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SPECIAL INSPECTOR QUIRED OCCUPANCY GROUP
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® RESIDENTIAL
LINE
❑ YE9 70
NEW
PLAN OHE xE BY THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
❑ SIGN
OF EDMONDS. LOCAL SALES TAX
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ADD
RETAINING
HOULD BE CODED 31.04.
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DEMOLISH WALL''
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ALTER EXCAVATE PENCE
10,r/sy�iclC'. ?-fa .J f'��/ U/ cs / F 7j
❑ On FILL (... ...... ........... Ft.)
REPAIR ❑
INSP. ziOVE O POOL
r S �S G' ✓N
NUMBER OF STORIES NUMBER OF
t DWELLING
UNITS /
N TUBE OWORK TO BE DONE
Valuation
Fee
Recclpt No.
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Plan Check No .....................
BUILDING
3 3=°
a, PROPOSED USE
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PLUMBING
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aPLOT
PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
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FENCE
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SIGN
RETAINING WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
[ormntlon given le correct: and that I are the owns'?, or the duly author.
Ired agent of the owner. I agree to comply with city sad state laws rcgo-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Stale of Washington
TIDS PERMIT
This application Is not a permit until
relating to Workmen's Compensation Insurance,
AUTKORizrs
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 Re
shall be completed In ninety days; MOVED -IN BUILDINGS shall be corn.
Icnowledged In space provided.
Pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
RE we BIGNA U
DEPARTMENT
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CITY OF
EDMONDEf
DATE r
NOTE: Applirant Subject to Plan Cbeck Fre
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775.2525
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Thls Penult r n ,.,it to be dans an private pro petty ONLY.
Any canmfrucllon on the public domain (curbs, sidewalks, driveways,
FILE
marquees, etc.) will require separate permission.
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BUILDING DEPARTMENT ApplleuntFill
ONE NUMBERPERMIT
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PERMIT APPLICATION I Insldo heavy Lines
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ADDRESS l
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/ I,3 G �"•- CI / ��l l-��� t� �•y�
NAME (OR NAME OF BUSINE8tl)
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LOT COVERAGE I.OT COVEAGE
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A1LIN0 ADDRSBBJ '� %A
PL•'1ta118tlIBLE HEIGHT `-�PROPOSED HEIGHT t� J� _1
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ACP AL LOT RE TOTAL 71
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CITY ..
TELE HONE UMBEII
YAlt UB PROPOSED YARDS
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NAME
FRONT BIDE REAR FRONT III REAR
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LEGAL LOT V RIANCE OR GOND ONAL
ADDRESS
��] YEd ;O P MIT NUM1LB
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CITY
ELEPHONE NUMBER
ITR/W
ET DEFICIENCY THIS PROPERTY
EXISTING STRE-
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NAME
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COMP. PLAN
REMARKS
slopes net to exceed t1�osr
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i'I;IiCute;i on standard Doty. `In. 103
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TELE ONE NUMBER%
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il)'I`r4/'11.-�":'It II `: �",IIf�Ini�t {'r�.F`l
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(r%
METER BILE SERVICE SIZE CLEARANCE
CHECKED BY
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STATE LICENSE NUh BER `,
'I C11Y LICENSE NU HEIt
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REMARKS
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Legal DeecrlPtmn e1 Properly (Shaw Below or Allach Four Copies)
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TYPE CfONNECTION
VERIFIED a-\
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
NO
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SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
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RESIDENTIAL
F1 LINE
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'R NEW
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
! % TAX
El NON-RESIDENTIAL
❑ SIGN
.' OF EDMONDS. LOCAL SALES
S/A.y.. / ' (.r BE CODED 31.04.
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ElADD
RETAINING
'I,' SHOULD
r'MARjt9/
DEMOLISH WALL
❑ FENCE
EXCAVATE
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❑ OR FILL (..........z..........Fl.)
PRE-MOVF. SWIM
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REPAIR ❑
INSP. POOL
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NUMBER OF STORIES NUMBER OF
WELL /
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."� UNITS
RE OFI' WORK TO BE DONE
Vnluallon
Fee
Recel Pt No,
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Plan Cheek No .....................
BUILDING
/ •:f(, !1 till
/ i G �r'
[O
W
PROPOSED UBE
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PLUMBING
7t •[),
HEAT A GAS LINE
ar
PLOT PLAN (Indicate B,IIIg�nOpeE 6uttln6 streets)
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m
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PENCE
1
SIGN
it
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RETAINING WALL
p l
ill...
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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I hereby acknowledge that I have read this application; that the In-
formation given le correct; and that I am the owner, or the duly author-
-
Ized agent of the owner. I agree to comply with city and elate laws regu-,
ATTENTION
APPLICATION APPROVAL
I.R.conetruetlan; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Stale of Woshlogton
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Ioeurance.
AUTHORIZES
signed by the Building Official or his Dep
NOTE: Permit Limit One Year (E—pt DEMOLITIONS which
IIF TIIE
WORK NOTED
uty; and fees are paid, and receipt is ac-
ehall be completed In ninety days; MOVED -1N BUILDINGS shall be cem.
knowledged in space provided.
plated In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNS
2NSPECTION
DIREOTOR'B /SIGNATURE r:
DEPARTMENT
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.- 'r,''-..t...<J .'. _.•,.: -.,•-••
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CITY OF
,ii11:•";)
EDhIOND3
DATE
/
NOT lac to P an Clrc •c
775-2525
This Penult coven work to bo done an Prlvata Properly ONLY.
Any cenelructian on the Public domain (curbs, sldewniks, drlrew'aye,
J
INSPECTOR
muaueer, etc.) will require eeperate permleelns
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