730492.pdf4
PERMIT
BUILDING DEPARTMENT Applicant Fin ZONE E NUMBER 730492
PERMIT APPLICATION i Inside Heavy Lines JOB
ADDRESS
NAME OR NAME OF BUSINESS)
n�/ / PERMItlBIflLE a
(rs G%/ C_Y S� l�/y(/ LOT COYERA6�VJOT
AOE i
f� MAILING ADDRESS O I
PERMISSIBLE HEIOIIT PROPOSED REIOHT I � •
O CITY �ID �1�e�.){{ Rom— ACTUAL LOT AREA TOTAL BLDG. AREA
2
^ / REQUIRED YARDS PROPOSED YARDS
NAME FRONT HIDE REAR FRONT SIDE REAR
[r
O LEGAL LOT VARIANCE Olt CONDITIONAL BE
M ADDRESS PERMIT NUMBER YE8 NO
I � N
I Q
a-
0
ElNEW
® ADD
ALTER
REPAIR
'!*e '/r7p
?� PROPOSED
^G PLOT PLAN
O
n
71/'
or
Is RESIDENTIAL GAS
LINE
ElNON-RESIDENTIAL SIGN
❑- RETAINING
DEMOLISH WALL
EXCAVATE FENCE
ORFILL El (........ .Z......... Ft.)
PRE -MOVE SWIM
INSP. POOL
IES NUMBER OF
DWELLING
UNITS
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP, PLAN ST. R/W ............FT. ............FT.
1thX";114:.
,W_H
YES �O
/lJ
THIS SITE 15 M
OF EDMONDS,
// GQn/sre a e,7�lo A/
Plan Check No, ....... _...... _...
yf�
lZ,4 BUILDING
PLUMBING
treets) HEAT A OAS LINE
FENCE
SIGN
RETAINING WALL
ISWIMMING POOL
DEMOLITION
I hereby acknowledge that I have read this application; that the in-
formation given is correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen'a Compensation Insurance,
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In bluely days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, drlvewrys,
marquees, etc.) will require separate permission.
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Valuation
044D047c1
IN THE
SALES
Fee
1
C.
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1
No.
TOTAL AMOUNT DUE I I INa `.e+.S�, S G
76
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPE
CTION .,v: • e MUM
DEPARTMENT
CITY OF
t s t . �•
•H 6-1107
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