740285.pdf{
( i
USE PERMIT
BUILDING DEPARTMENT Appncant Flll ZONE NUMBER I r1 j C;
V
PERMIT APPLI ATION Inside Heavy Lines V
NAM I/ ft NAME;
DU N R)
MAILING ADDRERe ,r
CIT _ I T LEYHONE U DKR
(y NAME
W ADDH BS
ADDRESS /
{/7�
' /
PP:ItTlltldtBLE M
LOT COVERAGFs
ACTUAL
LOT COVERAGE
PERMISSIBLE HEIGHT
PROPOSED HEIGHT
ACTUAL LOT AREA
TOTAL BLDG. AREA
REQUIRED YARDS PROPOSED YARDS
FRONT SIDE: HEAR FRONT SIDE HEAR
LF,GAI. LOT
0 YES [3 NO
VARIANCE Oft CONDITIONAL USE
PERMIT NUMBER
G � {
'LS I I
E
I
1
ii
u _
PLANNING DEPT. APPROVAL DATE:
CITY TELEPHONE NUMBER )
STREET ft/{V O
NAME
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY '
CODfP. PLAN 0T. R/W ............p'1'. ............FT. W
ROMA
C ADDRESSp ,
W
CHECKED BY
W i
F CITY ITE PHONE NUMBER ,
I ;
O
METER BILE I SERVICE SIZE 1 CLEARANCE 1 CHECKED BY l
Plan Check No .....................
In-
I hereby acknowledge that I have read this apDllcnUon;jb.-
TOTAL AMOUNT DISE
7.
formnRon given Is correct; and that I am the owner, or the or -
(zed agent of the owner. I agree to comply with city and elatgu-
REIdARHd
BUILDING
tall., construction; and In doing the work nuth.rI..d therebrson
e ,
i
regal Description of Property (Show Below or Attach Four Coples)
will be employed In violation of the Labor Code of the State ofton
THUS PERMIT
TYPE CONNECTION
VERIFIED BY
relating to Workmen's Compensation Insurance.
I
PLUMBING
NOTE: Permit Limit One Year (Except DEMOLIThich
FERC. TEST
O
a,
PERMIT NUMBER
in space provided.pleted
PLOT PLAN (Indicate Building setback., abutting street.)
I
HEAT A GAR LINE
GENT) DATE
INSPECTION
DEPARTMENT
0
W�
m
REMARKS
- .--•- " '
0
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
FENCE
YES I] NO
ED51ONDS
DATA
SPECIAL INSPECTOR REQUIRED GROUP
NOTE: Applicant Subject to Plan Check Fce
El NEW
ADD
ALTER
RESIDENTIAL
❑ NON-RESIDENTIAL
DEMOLISH
EXCAVATE
GAS
LINE
BION
RETAINING
WALL
CE
YES [I NO
PLAN CHECKED IIY
REMARKS
(OCCUPANCY
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 3104
,
'
E]RFILL
y.X..K z...>...Ft.)
RETAINING WALL
REPAIR
El PRE -MOVE
INSP.POOL
El SWIM
N
S
IUMBER OF STORIES NUMBER OF
DWELLING
SWIMMING POOL
UNITS
DEMOLITION
lATURE OF WORK TVE DONE
Velu.tlon
Fee Receipt NO.
EXCAVATION OR FILL
Plan Check No .....................
In-
I hereby acknowledge that I have read this apDllcnUon;jb.-
TOTAL AMOUNT DISE
7.
formnRon given Is correct; and that I am the owner, or the or -
(zed agent of the owner. I agree to comply with city and elatgu-
ATTENTION
BUILDING
tall., construction; and In doing the work nuth.rI..d therebrson
a� PROPOSED USE
will be employed In violation of the Labor Code of the State ofton
THUS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
(TRE
PLUMBING
NOTE: Permit Limit One Year (Except DEMOLIThich
WORK NOTED
O
i
.hall be completed In nicety day.; MOVED•IN BUILDINGS sas-knowledged
in space provided.pleted
PLOT PLAN (Indicate Building setback., abutting street.)
HEAT A GAR LINE
GENT) DATE
INSPECTION
DEPARTMENT
0
- .--•- " '
0
CITY OF
FENCE
ED51ONDS
DATA
NOTE: Applicant Subject to Plan Check Fce
i---�----
This i'ermlt c.Yen work lu be done an prlvgis properly ONLY.
775.2525
SIGN
Any <anstructlan on the public domain (curbs, sidewdke, driveway.,
RETAINING WALL
FILE
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
In-
I hereby acknowledge that I have read this apDllcnUon;jb.-
TOTAL AMOUNT DISE
r
formnRon given Is correct; and that I am the owner, or the or -
(zed agent of the owner. I agree to comply with city and elatgu-
ATTENTION
tall., construction; and In doing the work nuth.rI..d therebrson
APPLICATION APPROVAL
will be employed In violation of the Labor Code of the State ofton
THUS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
(TRE
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLIThich
WORK NOTED
uty; and fees are paid, and receipt Is ae-
i
.hall be completed In nicety day.; MOVED•IN BUILDINGS sas-knowledged
in space provided.pleted
pletedIn six months.)(O{VO
GENT) DATE
INSPECTION
DEPARTMENT
DIRE OR's QUINATUAE
' �• /
- .--•- " '
CITY OF
ED51ONDS
DATA
NOTE: Applicant Subject to Plan Check Fce
i---�----
This i'ermlt c.Yen work lu be done an prlvgis properly ONLY.
775.2525
Any <anstructlan on the public domain (curbs, sidewdke, driveway.,
marquees, etc.) will require separate permission.
FILE