740226.pdfNAME FRONT --.IDE --REAR FRONT SIDE REAR
oUj ADDRE13B LEGAL LOT VARIANCE OR CONDITIONAL USE
M O YES NO PERMIT NUMBER
PLANN 6 DEPT. APPROVAL DATE:
Q- CITY TELEPHONE NUMBER�Z r.C//U�./
cc STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
NAME
SELPCOMP. PLAN BT. R/W ............FT. ............FT.
t REMARKS
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PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
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3
NEW LINE
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Tee �ilzYea�,
PERC. TEST
(PERMIT NUMBER
OF EDMONDS. LOCAL SALES TAX
BUILDING DEPARTMENT
Applicant Fill
ZONE e„
N� BIS 744`AG2j^26
SHOULD BE CODED 3104.
PERMIT APPLICATION
Inside Heavy Lines
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ADDRESS
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NAME (OR NAME OF BUSINESS)
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FIRE ZONE TYPE OF CONSTRUCTION BTRE IMPROVED
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PERMISSIBLEE
LIDT COVERAGE
OTUAL
LOT COVRAGE
MAILING ADDRESS
PERMISSIBLE HEIGHT
PROPOSED HEIGHT
OCCUPANCY GROUP
220 14IRIN
UNITS
-
O CITY
TELEPHONE NUMBER
ACTUAL LOT AREA
TOTAL BLDG. AREA
Valuation
Ebi MWbs , WA -
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REQUIRED YARD.
PROPOSED YARI
NAME FRONT --.IDE --REAR FRONT SIDE REAR
oUj ADDRE13B LEGAL LOT VARIANCE OR CONDITIONAL USE
M O YES NO PERMIT NUMBER
PLANN 6 DEPT. APPROVAL DATE:
Q- CITY TELEPHONE NUMBER�Z r.C//U�./
cc STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
NAME
SELPCOMP. PLAN BT. R/W ............FT. ............FT.
t REMARKS
RESIDENTIAL GAS
O
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
if
3
NEW LINE
w
Tee �ilzYea�,
PERC. TEST
(PERMIT NUMBER
OF EDMONDS. LOCAL SALES TAX
m
m
O
REMARKS
SHOULD BE CODED 3104.
ALTER EXCAVATE FENCE
OR FILL .Ft.)
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N�
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FIRE ZONE TYPE OF CONSTRUCTION BTRE IMPROVED
El POOL
_17—may.. — hf� I E8 [3 NO
NUMBER OF STORIES NUMBER Oil
DWELLING
SPECIAL INSPECTOR pUIRED
OCCUPANCY GROUP
RESIDENTIAL GAS
(] YES
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
NEW LINE
NON-RESIDENTIAL ❑ SIGN
OF EDMONDS. LOCAL SALES TAX
ADD
DEMOLISH ❑ WALL KING
A=�
ARKS
SHOULD BE CODED 3104.
ALTER EXCAVATE FENCE
OR FILL .Ft.)
(.......... ..........
E] REPAIR ❑ PRE -MOVE! swim
El POOL
NUMBER OF STORIES NUMBER Oil
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Valuation
Fce Receipt No.
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Plan check xa.....................
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-
BUILDING
PROPOSED USE
aA ZL a
PLUMHIN6
0
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT A GAS LINE
-- MAIIJ ai_
art Dco:i
FENCE
i
SIGN
N
RETAINING WALL
(ZOO
b'
9WIMM1N0 POOL
B�
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DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
ALLC'e
I4 3)�-►I
I hereby acknowledge that I have read this appllcalton; that the in.
TOTAL AMOUNT DUE
ao D
o
formation given le correct; and that I am the owner, or the duly author-
Ized agent of the oweer. I agree to Comply wt city and elate law. reg.-
ATTENTION
APPLICATION—APPROVAL
luting construction: and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Stale of Wuhington
TIHB PEIte11T
This application is not ¢permit until
relating to Workmen'. Compensation Insuranu.
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 Be -
shell be completed In Neely days; MOVEDAN BUILDINGS shall be win-
ledged in apace provided.
pleted to six mootha)
BIG -LURE (OWNER OR AO T) DATE STONED
INSPECTION
DIRE BION URE
/�±DEPARTMENT
/
CITY OF
EDMOND$
ATE
NOTE: Applicant Subject to Plan Check Fee
PH 0-1107
This Permit covers work to be done on private property ONLY.
A.y eunOt,- len oa it,. publle domain (curb., ld—alk., driveways,
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