740228.pdfR
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RMIT
BUILDING DEPARTMENT I AppnfsntFlI LIKE
ja NUMBER 740228
PERMIT APPLICATION Inside Heavy Linea dos
ADDRESS
NA777��A1��A,��...¢�¢�l�)(OR NAME OF BUSINESS) '
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N / / \T A/ 5 PERMIBBIBL q LOT CO _
(„• (�• LOT COVERAGE LOT COVE
yyyM��I NO ADDRESS
A/ E7/'M Ljn V PERMISSIBLE HEIGHT PROPOSED HEIGHT 0
(�l( " I I
CITY,\,1 TELE -TONE NUMBER, ACTUAL LOT AREA TOTAL HLDO. AREA
EV1n N -2 / 3S REQUIRED YARDS PROPOSED YARDS
NAME FRONT SIDE REAR FRONT BIDE REAR
ADDRESS LEGAL LOT VARIANCE OR CONDITIONAL USE I1
� YES 0 NO PERMIT NUMBER
PLANNING DEPT, APPROVAL DATE: �I
CITY TELEPHONE NUMBER
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME
Sia v' 1 vCOMP. PLAN 8T. R/W ............FT. Fr, NREMARKS
C ADDRESS � i!
CHECKED BY !
F CITY I TELEPHONE NUMBER
O 1
O METER 81'LE SERVICE SIZE CLEARANCE I CHECKED BY
STATE LICENSE NUMBER I CITY LICENSE NUMBER
F II
Legal Description at Properly (Show Below or Attach Four Copies)
TYPE CONNECTION VERIFIED BY
I:
PERC. TEST PERMIT NUMBER d.
REMARKS m I
m
� I
G i ,
a
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES Ej NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP li
RESIDENTIAL GAB C]YES NO
ElNEWPINEPLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL 0 SIGN OFSHOULDDDND BE , LOCED AL
SALES TAX
El DEM0128H
ADD ❑ yEALL NX
ING REMARKS •i
ALTER EXCAVATE FENCE) ^
OR FILL ® Fl., i
REPAIR ❑ PRE-bIOVE SWIM
INSP. O POOL
NUMBER OF STORIESI NUMBER OF I
DWELLING
UNITS
NATURE OF WORK TO HE DONE Valuation Fee Receipt Na.
-�
' Plan Check N �
x
[O BUILDING
4 PROPOSED USE I -
PLUMBING
A PLOT PLAN (Indicate Building setback., abutting streets) HEAT A OAS LINE
U
FENCE
O�
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION '
PRE-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have reed this appllentlon; that the in.
formation given Is correct; and that I — the owner, or the duly au
Oror•
)zed agent
of the owner. I agora to comply With city and state laws raga• ATTENTION APPLICATION APPROVAL
taring Construction; and In doing the Work authorized thereby, no per.cn
Will be employerkmen's Compen.atlon d In vlol.U.. of the Labor Code of the State of Washington TIDE PERMIT This application is not s permit until
relating to WoImuraace. AUTHORIZES signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS Which oxiY THE uC d faid, and reset t is so-
.hall be completed 1. ninety day.; MOVED-IN BUILDINGS shall be corn. WORK NOTED P P
pleted In six months.) lanowledged in space provided.
Bio ATURE (OWNER OR AGENT) DATE SIGNED INSPECTION D CTOR'e '7,
IIKpp7NAT'
O T `� - �� DEPARTMENT J ,
r % i1
CITY OF
EDMONDS nA2
NOTE: ApQlican Subject to Plan Check Fee 7
PB a-1107
This Permit coven work to be done on private property ONLY.
Anyconelrucllnn nn the Dnbllc dnmaln (,orbs, eldrwnik., driveways,
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