740058.pdf•
BUILDING DEPARTMENT Applicant FW
USE
ZONEC/
PET
NUMBER 7:± 005(]
PERMIT APPLICATION Inside Heavy Linea
-yo-33
+�J C�
NAME (OR NAME OF HU8INE88)
ADDRES-t� �/ (/r
-/,0V/
' po
"U✓V L' U S
PERMISSIBLEACTUAL
IAT COVERAGE
ryry
AILING ADDR 88
LOT COVE AGE
0
�
PERMISSIBLE
PROPOSED
CITY
�O %7G ✓o,S
TELEPHONE NUMBER
ALR'UAL LOT AREA TOTAL BLDG. AREA Irl
NAME
REQUIRED YAADB
FRONT BIDE
PAOP08ED YARDS
REAR FRONT SIDF. REAR
-
p
U
14
14
ADDRESS
LEGAL LOT VARIANCE OR CONDITIONAL USE
YES 0 NO PERMIT NUMBER
ei
CITY
TELEPHONE NUMBER
Di P
AL �- -
a RE 1% W
EXIB N6 STREET R/W
............ F11 DEFICIENCY THIS PROPERTY
p
('
NAME
/' / S:/ �• -;
` p
COMP. PLAN ST. R/W
............FT. ............FT.
C
__
ADDRE 8
REMARKS
is
/�3/ yG S T o✓ ,� v.� y
w
'I
e�'
F
CITYI
TELEPHONE NUMHICFt
CHECKED BY
'
V
�y �7 �� /
STATE LICENSE NUaiHER
CITY LICENSE NUMBER
METER SIZE SERVICE
SIZE CLEARANCE
CHECKED BY
C „I
Legal Description 1 Property (Show Below or Attach Four Copies)
REMARKS
TYPE CONNECTION
VERIFIED BY
I
O
I
PERC. TEST
PERMIT NUMBER
d,
U
I
Oi
ItEMARKB
� I
r
0
I
.;
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES I] NO
SPECIAL INSPECTOR REQUIRED
1OCCUPANCY GROUP
RGAS
❑ E
NEW SIDENTIAL ❑ ('INE
❑ YES [3 NO
THIS SITE IS LOCATED IN THE CITY
PLAN CHECKED BY
❑ NON-RESIDENTIAL SIGN
OF EDMONDS. LOCAL SALES TAX
❑ Ann
❑ DEMOLISH ❑ RETAINING
REMARKS
WO tin BODED 31 04
❑ ALTER EXCAVATE FENCE
❑ OR FILL ❑ (..........z..........Ft.)
PREawl
❑
REPAIR
O INBPMOVE ❑ POOL
NUMBER OF STORILB t NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Fee Receipt No.
,
Plan Check No .....................
t
S `
BUILDING
f
U
PROPOSED USE
PLUMBING
PLOT PLAN (Indicate Building Setback., abutting streets)
HEAT k GAS LINE
e7
O
FENCE
SIGN
0
•I,
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
d-
/ v �b SoZ
TOTAL AMOUNT DUE
I hereby aeka Mledge that I have read thus application; that the 1n•
formation given le correct; and that r am the owner, or the duly author -
lied
agent the .wast. I agree to eowowith city and elate lane ergo-
latlag coneteuctloa; and to doing the work authorized thereby, an no paort
ATTENTION
APPLICATION APPROVAL
will beemployed In Viola Ran of the Labor Code of the State of Washington
to Workmen's Compen.atlon Iasursau.
THIS PERMITrelating
This application is not a perlalt until
Permit Limit One Year
AUTHORIZES
ONLY THE
signed by the BuildingOfficial or his De
Dep -
;'----'—
shall -IN Bt DINGS hall which
Shall h1 Completed In ninety day.; MOVED -IN BUILDINGS shall be win-
WORK NOTED
uty; and fees are paid, and receipt is ac -
plated to elz menthe.)
1.nt
lcnowled ed
g In apace provided.
ZSIATURE OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
IGN
-CITY
01-Yrb_
OF
19
NOTE: Applicant Subject to Plan Check Fee
EDMONDS
wTEIy
Pn ea307
_
T —
This Permit Torero pork be done ONLY.
private Derk71
li
AnY eonnin,rtlnn an the Puyllc domain (carbo, elArwnikn, drirenvnre,
(c y
as