740084.pdfBUILDING DEPARTMENT Fill
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NUMBER
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AppLLtaat
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Heavy Lines
PERMIT APPLICATION
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7ADDRESSBS 4
NAME (OR NAME OF BUeINE88)
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PERMISSIBLE %
LOT COVERAGE
ACTUAL JJ
LOT COVERAGE
MAiLINO ADDRESS
pEFlh118816LE fiE[OIIT
PROPOSED HEIGHT
CITY R
ACTUAL LOT AREA
TOTAL BLDG. AREA
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7,7
REQUIRED YARDS PROPOSED YARDS
1
NAME
FRONT 81—DE
REAR FRONT SIDEREAR
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LEOA.� LOr VARIANCE OR CONDITIONAL USF.
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ADDRESS
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PLA G DE A
V L DATE:
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CITY
E PHONE NUMBER
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EXISTI STREET R/W ............FT.
& DEFICIENCY THIS PROPERTY
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NAME
`REMARKS
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COMP. PLAN ST. R/W ............FT.
............FT,
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ADDDD/REE�{StS
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CHECKED BY
CIT TELEPHONE NUMBER
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METER SIZE SERVICE
SIZE CLEARANCE
CHECKED BY
STATE LICE010NUMBER CITY LICENSE NUMBER
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REMARKS
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Legal Description of Property ( ow Below or Attach Four Copies)
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TYPE CONNECTION
VERIFIED BY
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PERC. TEST
PERhi1T NUMBER
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REMARKS
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FIRE ZONE OF CONSTRUCTION STREET IMPROVED
(TYPE
❑YEA ❑ NO
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SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
RESIDENTIAL
❑ OAB
LINE
YES
❑ E] NO
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NEW
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
E] NON-REBIDENTIALSIGN
OF EDMONDS. LOCAL SALES TAXTAI
,
ADD ❑ NINE
O WALL
...ARKS
SHOULDBE CODED 31.04.
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DEMOLISH
ALTER EXCAVATE FENCE
OR FILL (......... .z.......... Ft.)
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REPAIR ❑ IN P. O PWIM
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NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Valuatton Fee ReCcIPt No.
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Pian Check No.. ...............
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BUILDING
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PROPOSED USE
PLUMBING
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PLOT PLAN (Indicate Building setbacks, abutting etreete)
HEAT & GAS LINE
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FENCE
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SIGN
1.
RETAINING WALLI
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SWIMMING POOL
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DEMOLITION
PRE-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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1 hereby acknowledge that I have read this application; that the In-
7
formation given Is correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with oty and .este laws regu-
ATTENTION
APPLICATION APPROVAL
Intlo6 couetructlou; and W doing the work authorlsed thereby, no person
will be employed In violation of the Labor Code of the Stals of Washington
THIS PERMIT
This application is not a permit until
n.athi to Workman's Compeo.aif.. Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
Uty; and fees are paid, and receipt is ac-
shall be completed In ninety nays; MOVED-IN BUILDINGS shall be core-
l[n0 edged in apace ovided.
pleted In sig month&.)
(OWNER O ONEDINSPECTION
DEPARTMENT
ITECA'8rTU
::;LUIIE
d/
CITY OF
EDMONDS
ATE
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NOTE: Applicant Subject to Plan Cheek Fee
Pn a-uo'I
This Permit coven work to be done on private property ONLY.
Any eon.truetlon on the public domain (curbs, sidewalk., dr"eway.,
FILE
marquees, etc,) will require ..pante Parmisslsn.
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