740368.pdfBUILDING DEPARTMENT USE PERMIT 740368 i
Applicant Fill zoxE xuMBER 1
PP
JOB
ADDRESS
PERMISSIBLE A r V o ACTUAL
W
LOT COVERAGE LOT COVESiAGE
PERMISSIBLE HEIGHT PROPOSED HEIGHT
ACTUAL LOT AREA TOTAL BLDG. AREA
REQUIRED YARDS PROPOSED YARUB
FRONT SIDE REAR FRONT BIDE REAR
LEGAL LOT AR NCE OR CONDITIONAL USE
YES 0 NO PERMIT NUMBER
PERMIT APPLICATION Inside Heavy Lines
NA�NAME�B�/�
m
`>(a
MAILING ADDRESS ) }-
O
CITY r��/�7 �y'
///"•V�//�
T �PF10NE NUM�H7b�R
77LL//'�� ��GCJ
PLANNING DEPT. APPROVAL DATE;
NAME
cc
ADDRESS
JOB
ADDRESS
PERMISSIBLE A r V o ACTUAL
W
LOT COVERAGE LOT COVESiAGE
PERMISSIBLE HEIGHT PROPOSED HEIGHT
ACTUAL LOT AREA TOTAL BLDG. AREA
REQUIRED YARDS PROPOSED YARUB
FRONT SIDE REAR FRONT BIDE REAR
LEGAL LOT AR NCE OR CONDITIONAL USE
YES 0 NO PERMIT NUMBER
7
O
nl
CITY
TELEPHONE NUMBER
PLANNING DEPT. APPROVAL DATE;
:, {
cc
I
STREET R/W
D
EXISTING STREET R/W
............Fr. DEFICIENCY THIS PROPERTY
!
O
nl
CITY
TELEPHONE NUMBER
PLANNING DEPT. APPROVAL DATE;
:, {
cc
I
STREET R/W
D
EXISTING STREET R/W
............Fr. DEFICIENCY THIS PROPERTY
!
NAMEOLC/�7�/G.�
COMP. PLAN ST. R/W
............Fr. ............FT.
.
REMARKS
14
ADDRESS
Ot
W
U
!
NUMBER
CHECKED BY
N
CITY
TELEPHONE
�
V
I
METER SIZE
SERVICE SIZE CLEARANCE
CHECKED BY
I
.TATE LICENSE NUMBER
CITY LICENSE NUMBEli
I
I
0.'
Legal Dcecrlp[lon of Property Shaw Below
or Attach Four Coplee),
REMARKS
'
TYPE CONNECTION
VERIFIED BY
j
y
-a,Ly&
PEIiC. TF•.BT
I PERMIT NUMBER
I
}
�r ��t,3z'iTl+ 51 t�,tLTT
W
REMARKS
ce
j
'D rev\ �Itvl� mI �/ se l� t
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
;
LlFifi st �4
PB NO
"/LI /�r Cxc�Q�- top
SPECIAL INSPECTOR REQUIRED OCCUPANCY GI110
QRESIDENTIAL
GAS
[3 YES C] NO
I
NEW
LINE
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
Nox•REslnExxtaL
atcN
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.09
i
17VL ADD
[j RETAINING
I❑--' DEMOLISH WALL
REMARK.
EXCAVATE: NCE /
ALTER OR FILL
REPAIR ❑ PRE -IM
INSPDIOVE ❑ POOL
NUMBER OF STORIES NUMBER OF
t
2 DWELLING '
I
UNITS
Tt/E OF l WORK TO HE/DONE
l D{'W,�•Jp`1T- /NCL
VDlu.tl.n
Fce Rccolpl No.
Pion Check Nu .....................
.O.
BUILDING
9h� 6PROPOSED
�
f�
PLUMBING
I
qG
W
PLOT PLAN (Indicate Hullding setbacks, abutting streets)
HEAT A GAB LINE
FENCE0
VV CC
SIGN
! I
RETAINING WALL
�
N
,
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION'
EXCAVATION OR FILL
I hereby acknowledge that i have rend this sDpllcnllon; that the In-
TOTAL AMOUNT DUE
=—
/
formation given Is correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
APPROVAL
Iating Cons Mellon; and In doing the work authorized thereby, no person
APPLICATION
will beemployed In violation of the Labor Code of the Slats of Washington
THIS I-ERn11T
This application is not a permit until
'
relating to Workmen'. Compen..un. Imuranre.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt Is ac -
.hall be complet alp day.; D ED -IN BUILDINGS shall be cam-
knowledged In space provided.
n et. unit,,.)
N UI low A
DATE IGNED
INSPECTION
DEPARTMENT
DI TOR'S SIGNAT RE
%
CITY OF
NOTE: Appft a Subject to Plan Check Fee
F,DMOND$
DArt'E
---
775-2525
��--•
This 1'cnit r
nark to be dune on private property ONLY.
eoo
Any struetloo on the public damaln (curbs, olds alk., drive.".,
'
nutrauer., etc.) .'ill revuirn separate Vernds.lon,
FILE