740284.pdfBUILDING DEPARTMENT Applicant Ft11 °NE NUMBER 7 40?94
PERMIT APPLICATION Inside Heavy Linea dDD /D ��
NAME (OR NAM OF BUBIfjEBe) ADDRESS
PERMISSIBLE (•(
/ LOT CDYERAOE LOT C VA�AGE
M MAILING AD REB. C
PERMISSIBLE HEIGHT PROPOSED HEIGHT x
c F��-TLS _ z
CITY TELEPHONE NUMBER ACTUAL LOT AREA TOTAL BLDG. AREA ,E
S
REQUIRED YARDS PROPOSED YARDS N
NAME FRONT SIDE REAR FRONT BIDE REAR
I
WADDRESS LEGAL LT VARIANCE OR CONDITIONAL USE
N� 0 YES 0 NO PERMIT NUMBER
U PLANNING DEPT. APPROVAL DATE:
CITY TELEPHONE NUMBER
STREET A/{V
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY V, a
NAME y6
G COMP. PLAN .T. R/W ............FT. ............FT. v
REMARKS ti
At AD1.138 x
! I CHECKED BY W
W CITY TELEPHONE NUMBER
METER BILL I SERVICE SIZE I CLEARANCE 1 CHECKED BY i I
0
4,
(a
S
v
PERC. TEST
PERMIT NUMBER
n
In
REMARKS
V
hiRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 YES 0 NO
J
,
SPECIAL INSPECTOR REQUIRED
❑ YES 0 NO
OCCUPANCY GROUP
GAS
RESIDENTIAL
NEW LINE
}
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL SIGNOF
LOCAL SALES TAX
I' DI
SHOULD BE CODED 3104
ADD RETAINING
i
REMARKS
DEMOLISH O
ALTER EXCAVATE FENCE',
On FILL (.........s..........Ft.)
❑ ❑
REPAIR ❑ PRE-DIOVE BtVIM
INSP. POOL
O
NUMBER OF STORIESNUMHER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
,(�// /� / ra'— 5� l� �+ �y�/'
lJrnf` ///I i'f-i- / UL`+ s� i�<�%�
Plan Cheek No .....................
Valuation Fee Recelpt No.
II
o `. C (� S EF�
BUILDING
a PROPOSED DUE
j
I
O
PLUMBING
O A
r V
A PLOT PLAN (Inlllcnle IIulldln6 eclbneka, nbuttln6 streets)
HEAT & GAS LINE
21
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I heresy nekaowledge that I have rend this application; that the In.
TOTAL AMOUNT DUE
atlon given Is correct; and that I Am the owner, or the duly author-
(�
,zed
ized agent of the owner. I agree to comply with city And state laws ragu•
lalln9 construction; and In doing the work Aulhorleed thereby, no Person
ATTENTION
APPLICATION APPROVAL
will be employed In violation or the Labor Coda of the State of Washington
relating to Workmen's Compensation
TIDE PERMIT
This application is not a permit until
Inournnce.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY
ONLY
NOTED
Uty; and fees are paid, and receipt is ae-
plHE
In nicety days; MOVED -IN BUILDINGS shell he cam-
ete be completed ix months.)
pletetl In elz months.)
knowledged in space provided.
SIGN E (ONN OR AGENT)
1 Flo
DEPARTMENT INSPECTION
Di OR's f1[GNAT
F� l
CITY OF�utij
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
This Permit raven work to bo done on property ONLY.
P.,
775-2525
Od
Any const nlrtlan on the public domain (Cnrhn, nldewAlke, driveways,
",!iiia-,• Sirs "III ri nalrr 1111rratr p.•rn.Noon.
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