740146.pdf- - - - _ --
RESIDENTIAL
Volunllan Fee Receipt No.
GAS
f
L+
Plan Check No .....................
BUILDING DEPARTMENT
®
PERMIT 740146
NUMBER
El
Appuli"t Fill
USE
ZONE
PERMIT APPLICATION
Inglde Heavy Lines
ADDRESS
JOB�q(m
AL NINO
® ALTER
DEMOLISH
EXCAVATE
❑
INS
NAME (OR NAME OF�Ig/UBIN )\(\
PLOT PLAN (Indicate Building setbacks, abutting streets)
on/
C. x. Ft.)
REPAIR
❑
Ed
O
PER
J
FENCE
I
rh O N V Cj O tT
�Dl j � �
COVE A
LOT COVERALL
LOT CO
LOT COVERAGE
DWELLING
I
RETAINING WALL
MAILING ADDRESS
�, S.
19 (o —,, �-U).
PERDSI88IBLE HEIGHT
PROPOSED HEIGHT
D
yy3��S�oa–
CIT W FYP (/1 G 0�4 l (Ji;RJ�I-I
�� ONE NUMBEER
ACTUAL LOT AREA TOTAL BLD.. AREA
REQUIRED YARDS PROPOSED YARDS
U
ag
6
0 YES [:) NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. I.T.............
REMARKS
0 YES El NO
❑ YES [3 NO
SALES TAX
RESIDENTIAL
Volunllan Fee Receipt No.
GAS
E] NEW
L+
Plan Check No .....................
LINE
®
NON-RESIDENTIAL
El
SIGN
---RETEl
El
PLUMBING
❑
AL NINO
® ALTER
DEMOLISH
EXCAVATE
❑
PLOT PLAN (Indicate Building setbacks, abutting streets)
ORFILL
C. x. Ft.)
REPAIR
❑
MOVE
INS.EP
O
WI
POOL
FENCE
I
IUAfBER OF STORIES
NUMBER OF
SIGN
DWELLING
I
RETAINING WALL
UNITE
0 YES [:) NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. I.T.............
REMARKS
0 YES El NO
❑ YES [3 NO
SALES TAX
Volunllan Fee Receipt No.
', I
Plan Check No .....................
! 1
FBUILDING
/O O G�
<II
e. PROPOSED USE
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT @GAS LINE
FENCE
I
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE�^
I hereby acknowledge that I have read this applleatlon; that the In.
formation given Is correct; and that I am theowner, or the duly author -
Ind agent of the owner. I agree to comply with city and state law. regu-
ATTENTION
APPLICATION APPROVAL
laung conatruetionE and In doing the work authorized thereby, no person
will be employed In violation of the Labor code of the State of waahtnaton
THIS PERMIT
This application is not a permit until
'
relating to Workman's Compensation Ituuraau.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY Tld\:—�"r--,
WORK NOTED
uty; and fees are paid, and receipt is ac-
ahali be completed In Wooly days; MOVED•IN BUILDINGS .hall be nom-
knowledged In space provided.
pleted In six months.)
SIGNATOR IOWNER �011 AO NT), DATE SIGNED
IG
�QrLyJI�/�, !/
INSPECTION
DEPARTMENT
Di OR'B B10NATU E
,r
CITY OF
ti.�,�.: ✓w�. ���>./;�'?L.t :(a
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
PA g•1307
—
This Permit coven work to be done on private property ONLY.
Any construction on the Public domain (curbs• sidewalks, driveways,
!'I I.P•.
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