750243.pdfi BUILDING DEPARTMENT zO "u'$�'t 75024.;
Applicant Fill
�. PERMIT APPLICATION
Inside ETeavy Lines JOB
ADDRESS
NAME (OR NAME OF BUSINESS) 21507 -86th Avenue West
Samuel A. Mitchell PEIiAIItlSIOLE ACTUAL
LOT COVERAGE LOT COVERAGE
N MAILING ADDRESS
PERMISSIBLE HEIGHT PROPOSED HEIGHT
W t
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21507 -86th Ave. e5
NU MIIER
ACTUAL LOT AREA TOTAL BLDG. AREA
I
CITYTELEPfiONO
N
Edmonds Wa.
778-8428
REQUIRED YARDS PROPOSED YARDS
{
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NAME FRONT BIDE REAR FRONT SIDE REAR
LOT VARIANCE Olt CONDITIONAL USE
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ADDRESS
LEGAL
0 YES NO PE ItMiT NUMBER
1
N
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PLANNING DEPT. APPROVAL DATE:
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a�
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CITY TELEPHONE NUMBER
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STREET R/W
p
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RESIDENTIAL
❑ GAS
0 YES 0 NO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
'
NAME
�(J
COMP. PLAN ST. R/W ............Fr. ............FT.
� 1
THIS SITE IS LOCATED IN THE CITY
REMARKS
NON-RESIDENTIAL
SIGN
ADDRESS
OF EDMONDS. LOCAL SALES TAX
'
D
RETAININGA
REMARKS
SHOULD BE CODED 31.04.
W
U
EE
ti
CRECKED BY
ALTER EXCAVATE ❑ FENC:
CITY
TELEPHONE NUMBER
I
ORFILL .......... Ft. 3
I
REPAIR ❑ PRE-SWDI
INSP. POOL
I CHECKED BY
G
STATE LICENSE NUMBER
AIETER SIZE I SERVICE SIZE I CLEARANCE
I CITY LICENSE NUMBER
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PERO. TEST
PERMIT NUMBER ad
I
N
j
1
REMARKS
i
1
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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I
(DYES ONO
I
SPECIAL INSPECTOR REQUIRED GROUP
j -j
RESIDENTIAL
❑ GAS
0 YES 0 NO
(OCCUPANCY
NEW
�(J
LINE
PLAN CHECKED HY
THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
SIGN
OF EDMONDS. LOCAL SALES TAX
'
ADD
RETAININGA
REMARKS
SHOULD BE CODED 31.04.
DEMOLISH
❑ ❑
ALTER EXCAVATE ❑ FENC:
'
ORFILL .......... Ft. 3
REPAIR ❑ PRE-SWDI
INSP. POOL
NUMBER OF STORIES NUMBER Oil
DWELLING
I
UNITS
NATURE OF WORK TO HE DONEVnluatlon
Fee
Recalpt Na
COMPLIANCE INSPECTION
flan Check No.
BUILDING
a PROPOSED USE
PLUMBING
O PLOT PLAN (Indicate Bulldlns eetb¢eka, nbuttlns Streets)
HEAT do GAS LINE
FENCE
SIGN
I
RETAINING WALL
SWIMMING POOL
DEMOLITION
I
PRE -MOVE INSPECTION
EXCAVATION OR FILL
25.00
TOTAL AMOUNT DUE
25.00
I hereby acknowledge that I have read this application; that the fn -
formation given Is correct; and that I ant the owner, or the duly author.
(zed agent of the owner, I agree to comply with city and state Tawe regu•
ATTENTION
APPLICATION APPROVAL
lating canetruetlon; and In doing the work authorized thereby, no person
Will be employed In vfolat'on or the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZER
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 -
.hall be completed In ninety days; MOVED -IN BUILDINGS shall be co—
llllowledged In space provided.
pleted In six month..)
SIGNATURE (OWNER Olt AGENT) DATE SIGNED
INSPECTION
DIRE01 OR'S QIONATUrE
DEPARTMENT
1 /, 1,`•-
hwast Bonded ort a e 5-28-75
CITY OF
NOTE: Applicant Subject to Plan Check Pee
EDDIONDS
DATE
'7
775-2525
+-- —""
Thl. Permit r Yers Work to be, done en private properly ONLY.
Any conelrucl l.a. on the public dumaln (curb., .ld—alk.. drlreways'
FILE
nntrauees, Ile.) will results .epar¢le pe-A.M...
1ZONE
BUILDING DEPARTMENT I AppHeant Fill
USE PERMIT
NUM13ER 77r 24
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Inside Heavy Lines
SOB
PERMIT APPLICATION
ADDRESS
71507-8ul'h PyPllUfa wes-f
NAME (OR NAME OF BUSINESS)
1,TMISSIBLE ACTUAL
COVERAGE
�i)f.11lr.-:1 (�l. t•�Iil'.hCl
LOT COVERAGE LOT
MAILING ADOHEtlB
i4eest
PERMISSIBLE HEIGHT P120P08ED HEIGHT
O
.1
-OITY
2 1 507-301 1, Ave.
TELEPHONE NUMBER
ACTUAL LOT AREA TOTAL BLDG. AREA
(:rJrnonc! i IVa.
778-8423REQUIRED
YARDS PROPOSED YARDS
NAME
FRONT SIDE REAR FRONT SIDE REAR
`
M
LEGAL. LOT VARIANCE OR CONDITIONAL USE
YES NO PERMIT NUMBER
ADDRESS
Q
;
PLANNING DEPT. API•ROVAL DATE:
CITY
TELEYICONE NUMBER
STREET 1[/{V
�
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
O
NAME
COMP. PLAN ST. R/W ..........,.Fr. ............FT•
Id
REMARKS
E
,
e1
ADDRESS
u
z
BY
CITY
TELEWHIII NUMBER
(CHECKED
F
z
I
METER 812E
SERVICE SIZE CLEARANCE
CHECKED BY
STATE LICENBE NUMBER
CITY LICENSE NUMBER
I I
i
C
REMARKS
<
Legal Description of Property (show Below or Attach Four Copies)
lot A Row- Aridltion
TYPE CONNECTION VERIFIED BY
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PE tC T D E UMHFjRy.
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¢7
RE CS
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1
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
I0YES
ONO
I
SPECIAL INSPECTOR REQUIRED
GROUP
GAB
JV RESIDENTIAL LINE
NEW11:1 H
❑ YES (:1 NO
IOCCUPANCY
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
NON-RESIDENTIAL SIGN
SHOULD BE CODED 31A4.
ADD ❑
❑ WALL C]ING
REMARKS
DEMOLISH
ALTER EXCAVATE FENCE
OR FILL (.......... x .......... Ft.)
REPAIR ❑ INSPMOVE SWIM
a POOL
NUMBER OF STORIES NUMBER OF
'
DWELLING
I
UNITS
NATURE OF WORK TO BE DONE
Valuation
Fee Receipt No.
-
q
C� "4Pl_ I AJ-.,.- f FIS'•'CC ! I Q.:'
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Plan Check No .....................
BUILDING
I7
0,
PROPOSED USE
PLUMBING
O
aPLOT
PLAN (Indicate BulldliI; etbnCks,-4¢\ ttng street.)
HEAT & GAS LINE
-
JC-�l((
PENCE
,
SIGN
RETAINING WALL
IN
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
•
EXCAVATION OR FILL
2`:.00
TOTAL ATIOUNT DUE
2r (IV
I hereby acknowledge that I have read this application; that the In-
formation given le correct: and that I ant the owner, or the duly author-
Ired agent 11 the owner. I agree to comply with City and .tate law. Mgu-
ATTENTION
APPLICATION APPROVAL
-
Iating construction; and In doing the want authorlred thereby, no person
will be employed In violation of the Labor Code of the Slate of Washington
TIUS PERMIT
This application is not a permit until
'
relating to Workmen'. Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
WORM NOTED
uty; and fees are paid, and receipt is ac
shalt be completed In ninety days; MOVED -IN BUILDINGS shall be cont-
knowledged in space provided.
plated In six menthe.)
SIGNATURE (OWNER Oil AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
Di TOR'B IGIiATU E I
rI /
I
,%•e(
.,���.t.;. '.;ul f.�.,�._•e -%^
CITY OF
T:
EDMONDS -
DATE _
y-- '-
Fee^-
NOTE: Applicant Subject to Plan Check
775-2828
'f /
This Permit c n work to be done on private property ONLY.
Any eonstruclieu on the public domain (,.,be, sldewallu, drly—.r.'
INSPECTOR
marquees, ele.) will require sepnr.le permission.