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BUILDING D E P A R T M E NT Applicant FLU ZONE ]p NUMBER 750308
PERMIT APPLICATION I Inside Heavy Lines JOB
G -•/nom
NAME (OR NAME ON BUSINESS) ADDRESS a
_ PERMISSIBLEACTUAL 1
LOT COVERAGE 0� LOT COVEAGE I �D�
M MAILING ADDRESSPli RMISSIBLE HEIGHT ( PROPOSES HEIGHT n
fgC�E X2.2 z
CITY TELEPHONE NUMBER ACl'UAL 4EOOVIRF.D�AI TOTAL P$I/'�•�tE YARDS
re,i,.✓ps 04sj) 7A -� 3.3 1 r I►O
NAME FRRJONNT SIDE }}••REAR FRONT SIDE REAR 11
Pik
W ADDRESS LE LOT VARIANCE Olt C
Olt CO DITIONAL S'�—
(., ES (j NO PERMIT NUMBER
7
CITY TELEPHONE NUMBER STREET t r -D
EXISTING U:YdHIS
V I
PROPERTY a
NAME t, ,1 ) .�y�[] -}�/� r(
O � Ili /� / -/T7 / J7�� REG[ARKO LAN BT. R/W�J/rG!.K7'. ......1.l..FT. W
m ADDRESS Driveway slopes not to exceed those o
�e a Q O indicated on Standard Bwg. No103 w
FC �� I C'KED BY
Cl•1'Y TELEPHONE NUMBER j t1}unt/�i
4 •� d /V) -)S w, 177- �a 33 .
(Vj MET�ILE I Shl� SIZEI CLEARANCE I cHEC
NUMBERIkd1 - i
STATE LICENSE NUMBER I CITY LICENSE NUMBER
REMARKS ) ! 1
Legal Description of Property (Show Below or Attach Four Copies) ,t
/ M, -1,1,1x'
TYPE CONNECTION V RIFIE It
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PER.. TEST P -MI UMBER
J' ") REMARKS
to
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..4 FIRE ZONE
TYPE OF CONST UCTION BT1tEFeT IMPROVED
JZ7t �� �I¢/ES 0 NO
SPECIAL INSPE�CyT1O/pRj[EpUIRED OCCUPANCY GROUP
RESIDENTIAL GAS [3 YES .rwf/
NEN ❑ PINE PLAN CHECKED BY / THIS SITE IS LOCATED IN THE CITY 1
❑ NON-RESIDENTIAL ❑ SIGN , Z" 11 / OF EDMONDS. LOCAL SALES TAX
❑ ADD t•a.i/.L• SHOULD BE CODED 31.04.i
DEMOLISH ❑
RETAINING Ij'FMARIS)4) .
• ALTER EXCAVATE FENCE VV ((�/` 19,
OR FILL ❑ (.......... x ..........
Ft.)
ElREPAIR PRE -MOVE POOL
. ❑ INSP. ❑ POOL �d/i 7-G C? i 'TO r': •✓ 5i/Z' /if/Sf'..—c:^ /i / -
NULIBER OP 6TOlil ES
UMBER OF '
DWELLING
0/\ UNITS
NATURE OF LYORK TO BE DONE ) Valuation Fee Receipt No.
/il�W• %iJMr /'It✓STn./�/dry Plan Check No .....................
-V• /� BUILDING C^�' 130
� nlroeosen vBE
PLUMBING C;?,
O PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT A GAS LINE
'+ 60 FENCE
— f
5 Sr
SIGN
TOTAL AMOUNT DUE
— f
SIGN
TOTAL AMOUNT DUE
VIN
RETAINING WALL
"ongiven Is correct; and that 3 am the owner, or the duly _arbor-
(yI
SWIMMING POOL
-
Ized agent of the owner. I agree to comply with city and stale laws Ingo-
Iating construction; and In doing the work authorized thereby, he person
gTTENTION
APPLICATION APPROVAL
DEMOLITION
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
1`
PRE -MOVE INSPECTION
AUTHORIZES
ONLY THE
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
EXCAVATION OR FILL
shall be completed In ninety days; MOVED -IN BUILDINGS shall be coon.
— f
ihereby acknowledge that I have rend this application; that the In-
TOTAL AMOUNT DUE
(�
"ongiven Is correct; and that 3 am the owner, or the duly _arbor-
-
Ized agent of the owner. I agree to comply with city and stale laws Ingo-
Iating construction; and In doing the work authorized thereby, he person
gTTENTION
APPLICATION APPROVAL
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance,
AUTHORIZES
ONLY THE
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
fes
llty and fees are paid, and receipt Is aC-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be coon.
IInOWIBd apaceprovided.,anr
Pleted In six months.)
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B30NA R WNEI{� OI ENT DATE BIGNE }}}���
/
INSPECTION
DEPARTMENT
•
HE O BIG
S
CITY OF
NOTE: Applicant Subject to PlanCheck Fee
EDDIONDS
DATE
r
_• �%�
'�
This Pe It work to bo dao , prh•ate property ONLY.
775-2525
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.4n)• roost nlellmr on the Po hlir. Aomnln fenrhl, sldrwnikn, drivennyn.
rpi, .••, r „III rWlr, +epnrnte ,ale.
PILI:
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The East 60 feet of the following described property:
Beginning at a point 516.50 feet East and 60.00 feet South of the
` Northwest corner of the Southwest quarter of the Northwest quarter
of Section 25, Township 27 North, Range 3 East, W.M,; thence running
South 180 feet thence West 125 feet; thence North 180 feet; thence
East on road 125 feet to point of beginning.
Subject to: A Subsurface oil and gas lease recorded under
Auditor's File No. 2249037.
I
REAL ESTATE SALES TAX
AMOUNT PAIDr
S!f1LGF RECEIPT N0. 7t�(
!;
JUN 17
,,, - ►:IES � �9ffS, �natomic� Ca I� lt:a'�r
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