740149.pdfI
BUILDING DEPARTMENT
ONE NUMBER 4
Applicant Fill
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BUILDING
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PERMIT APPLICATION
Inside Heavy Lines ]O
ADDRESS
4 PROPOSED USE
a70,
PLUMBING
NAM (OR NAME O USINEHB) a
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( ( LOT COYERAGEe LO OVERAGE
5 l --JL O LOT CO9IBLE ^ ACT L y
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PLOT PLAN (Indicate Building setbacks, abutting streets)
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MA NO ASD -"FE-r /j
,/� PENM189IBLE HEIGHT YROPOHED 1[ElOHT
tFE �
O CITY 2/l%/G�•`e!'/ TE PHONE N MHEft ACTUAL LOT AREA TOTAL BLDG. AREA
REQUIRED YARDS PROPOSED YARDS
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NAME FRONT HIDE REAR FRONT SIDE, REAR
y LEGAL LOT VARIANCE OR CONDITIONAL USE
ADDRESS
❑ YES NO PERMIT NUMBER
UPLANNING $PT. AP V L ATE:
C CITY TELEPHONE NUMBER /W ✓
Q
"ION
!c STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
RETAINING WALL
N
...........FT.
/ / / pyl 1/%/[- r�/ REMARKS
C!/� r / COMP. PLAN BT. R/W ............FI'.es
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Imo'
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SWIMMING POOL
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CHECKED BY
0.1 CITY lli
o Se -le-
TELEPHONE NUMBER
I36/j�—�S ZS— /� ',SERVICE
METER SIZE SERVICE SIZE CLEARANCE
DEMOLITION
CV CKE BY
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ttty
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STATE LICENeE NUMBER /9
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CITY LICENBE NUMBER
I REMARHH
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Lcgn1 Deacription of Property (Show Below or Attach Four Copies)
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TYPE CONNECTION VERIFIED BY�
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Lam- 77a7
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y, PL•'RC. TEST I PERMIT NUMB
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I hereby acknowledge that I have rend this application; that the In-
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REMARKS
en
Ixed agent of the owner. I agree to comply with city and elate Inmos rogu-
FIRE ZONEI TYPE T J
0 ie/R7ON RESMPORNO D
APPLICATION APPROVAL
toting conetMellon; and In doing the work authorised thereby, no Peroon
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
RESIDENTIAL GAS ❑ YES
NEW LINE PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIALBION . OF EDMONDS. LCODEOCAL SALES TAXIIE
04
ADD RETAINING MARKS
DEMOLISH El WALL
ALTER EXCAVATE ❑ FENCE
LJOR FILL ..........:..........Ft.)
REPAIR PRE -MOVE SWIM
IN"P. POOL
TIDE PERMIT
This application is not a permit until
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relatlog to Workmen's Compensation Insurance.
AUTHORIZES
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NUMBER OF STORIESDWELNUMBER OF
oxl.Y THE
y ��.(� �.r�
a[ UN ITS % r-��/1]_/�/�T/!/
shall be completed In nicely days; MOVED -IN BUILDINGS shall be cam-
WORK NOTED
Plan Check No .....................
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BUILDING
eJG
QQ U
6
4 PROPOSED USE
a70,
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT A GAS LINE
FENCE
I
"ION
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Lam- 77a7
TOTAL AMOUNT DUE
I hereby acknowledge that I have rend this application; that the In-
formation given le correct; and that I am the owner, or the duly author-
Ixed agent of the owner. I agree to comply with city and elate Inmos rogu-
ATTENTION
APPLICATION APPROVAL
toting conetMellon; and In doing the work authorised thereby, no Peroon
will be employed In violation of the Labor Code of the State of Washington
TIDE PERMIT
This application is not a permit until
relatlog to Workmen's Compensation Insurance.
AUTHORIZES
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NOTE: Permit limit One Year (Except DEMOLITIONS whish
oxl.Y THE
signed by the Building Official or his Dep -
Utyi and fees are paid, and receipt Is ac -
shall be completed In nicely days; MOVED -IN BUILDINGS shall be cam-
WORK NOTED
knowledged in space provided.
pletc4 In sl: months.)
810 U (OWN OR's/]A�G�ENT)
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DATE STONE7D
INSPECTION
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DEPARTMENT
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OITY OF
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EDMONDS
ATE
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NOTE: Applicant Subject to Plan Check Fee
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Thin i'crmll coverswork In be done an prh'a to Property ONLY..
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Any nnrtrnelienon the pnhlk domain (curbs, elden,alL., drlveway