740280.pdfj
BUILDING DEPARTMENT Applicant Flu Z NE NUMBER 740280
PERMIT APPLICATION I Inside heavy Lines
NAME (OR NAME OF BUSINESS)
S c, bq rt'k C . F -6r
MAILING AD HE
�- I Q
CITY TELEPHONE NUMBER
L
NAME
ADDRESS
SOB
ADDRESS 0) / 7
Dd RESIDENTIALGAS
1
PERMItlS1BLE
LOT COVERAGE
CT
LOTAL COV&GE
❑
PERMIHSIBLE HEIGHT
PROPOSED HEIGHT
SIGN
WALLKING
FENCE
ACTUAL LOT AREA
TOTAL BLDG. AREA
e. PROPOSED USE
6Y,
REQUIRED YAItUS
FRONT SIDE REAR
PROPOSED YARDS
FRONT SIDE REAR
x .......... Ft.)
REPAIR
LEGAL LOT VARIANCE OR CONDITIONAL USE
0 YES i] NO PERMIT NUMBER
PRE-SWIT
INSP.
V PLANNING DEPT. APPROVAL DATE:
G' CITY TELEPHONE NUMBER
!s BTREEP R/W 0
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME // COMP. PLAN ST. R/W ............FT. ............FT.
F/J r "}�!_ 14 t of U REMARKS
0 C_,0
NEW
Dd RESIDENTIALGAS
1
LINE
ADD
ALTER
❑
NON-RESIDENTIAL
O
❑
SIGN
WALLKING
FENCE
❑
j6
e. PROPOSED USE
6Y,
❑
y
(
x .......... Ft.)
REPAIR
❑
V PLANNING DEPT. APPROVAL DATE:
G' CITY TELEPHONE NUMBER
!s BTREEP R/W 0
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME // COMP. PLAN ST. R/W ............FT. ............FT.
F/J r "}�!_ 14 t of U REMARKS
0 C_,0
NEW
Dd RESIDENTIALGAS
LINE
ADD
ALTER
❑
NON-RESIDENTIAL
O
❑
SIGN
WALLKING
FENCE
❑
DEMOLISH
EXCAVATE
e. PROPOSED USE
6Y,
❑
RFILL
OR
x .......... Ft.)
REPAIR
❑
PRE-SWIT
INSP.
PLOT PLAN (Indicate Building setbacks, abutting streets)
POOL
UMBER OF STORIESI
NUMBER OF
5
DWELLING
FENCE
UNITS
0 YES [] NO
(] YES i] NO
OF
Valuation I Fee
Z
Plan Check No .....................
O
BUILDING
e. PROPOSED USE
6Y,
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
—
5
O
FENCE
SIGN
I
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
1 hereby acknowledge that I have read this application; that the in.
i L
formation given Is correct; and that I am the owner, or the duly author•
Ized agent ofthe owner. I agree to comply with city and state laws regu•
ATTENTION
APPLICATION APPROVAL
and
leling construction; and In doing the work authorized thereby, no person
will be employed In of the Labor Code of the elate or Washington
THIS PERMIT
This application is not a permit until
rslatill to Workmen's CompenseRed Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Escopt DEMOLITIONS which
ONLY TILE
WORE NOTED
uty; and fees are paid, and receipt is ac -
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
knowledged In apace provided.
pleted In six month..)
(OWNER R AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
Dili+ OJi'8 S10NA U/R
(I1�, \-J�•'V
ERE
/, ./�J� L; V�/r�(/,f
CITY OF
/1J
NOTE: Applicant Subject to Plan Check Fre
EDMONDS
DATE
/S (�
775-2525
This 1'ennll c,rrn work to bo done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
mnrqu—, etc.) .111 require eq.—fir pefndeslon.
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