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BUILDING
PFAMIT
DEPARTMENT
APPLICATION
ApplicantFill
Inside Heavy Lines
USE
PERMIT ZONE NUMBER 740406
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ADDRESS g F * _ 9 a ♦
BUILDING
N (OR NAM B1NEB8)
Ized agent of the owner. I agree to camply With city and state laws regu•
ATTENTION
tO
W PROPOSED USE
lating construction; and in doing the wort[ authorized thereby, no person
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PERMISSIBLE % ACTUAL/
LOT COVERAGE LOT COVEIIAOPI
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All NG ADDRESST
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THIS PERMIT
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PERMISSIBLE HEIGHT PROPOSED HEIGHT
1,2J
TELEPHONE
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NUMB&I1,
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ACTVAL LOT AREA TOTAL BLDG. AREA
ftEpVIRFD YAS(DS PROPOSED YARDS
FRONT SIDE REAR FRONT BIDE REAR
HEAT & GAS LINE
NAME
tlIF TURE (OWNEENT) DATE SIGNED
INSPECTION
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LEGAL LOT VARIANCE M1 CONDITIONAL BE
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PLANNING DEPT. APPROVAL DATE:
CITY
RETAINING WALL
TELEPHONE
NUMBER
R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
V,
cSTREET
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NAME'
Tble I'ern,lt r vrr. work to be dmie on Private property ONLY.
COMP. PLAN ST. R/W ............FT. ............FT.
SWIMMING POOL'
REMARKS
nuvauree, ete.l .111 re&ulre separate perndsel.n.
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DEMOLITION
A1335REBS
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PRE -MOVE INSPECTION
(CHECKED BY
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TELEPHONE NU" n
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER
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REMARKS
Legal Description of Property (Show Below or Attach Four Coplee)
TYPE CONNECTION
VERIFIED BY
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PERC. TEST
PERMIT NUMBER
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET ILSPROVED
[] YES [I NO
SPECIAL INSPECTOR REgUIRED
OCCUPANCY GROUP
❑ YES NO
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RESIDENTIAL ❑ GAS
0 NEW LINE
NON-RESIDENTIAL SIGN
PLAN CHECKED IIY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD 8E CODED 31.04.
D ADD
❑ ALTER
❑ DEMOLISH
EXCAVATE
RETAINING
WALL
FEN�,pLt}`E,y
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REMARKS
Fence requirements - section 12.14.040
OR FILL (/�IJ.g .Fl.)
El REPAIR
❑ PRE -MOVE
INSP.
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attached.
NUMBER OF STORIES NUDfIIER OF
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DNELLIN6
UNITS
NATURE OF { HE E
Valuation
Fee Recelpt
No.
nTO w1)
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Pian Check N. .....................
TOTAL AMOUNT DUE
7.
I hereby acknowledge that I have read this application; that the In-
a ov
formation given le correct; and that I em the owner, or the duty nulhor-
BUILDING
Ized agent of the owner. I agree to camply With city and state laws regu•
ATTENTION
tO
W PROPOSED USE
lating construction; and in doing the wort[ authorized thereby, no person
�q
THIS PERMIT
PLUMBING
relating to Workmen's Compeneatlan Imurmtce.
AUTHORIZES
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NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
Uty; and fees are paid, and receipt is ac-
Z PLOT PLAN (Indicate Building setbacks, &butting street.)
HEAT & GAS LINE
tlIF TURE (OWNEENT) DATE SIGNED
INSPECTION
7
FENCE
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OF
SIGN
ebbIONDS
DAT!•.
RETAINING WALL
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Tble I'ern,lt r vrr. work to be dmie on Private property ONLY.
SWIMMING POOL'
FILE
nuvauree, ete.l .111 re&ulre separate perndsel.n.
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
a ov
formation given le correct; and that I em the owner, or the duty nulhor-
Ized agent of the owner. I agree to camply With city and state laws regu•
ATTENTION
APPLICATION APPROVAL
lating construction; and in doing the wort[ authorized thereby, no person
will be employed In violation of the Labor Code of the State of Wushloston
THIS PERMIT
This application is not a permit until
relating to Workmen's Compeneatlan Imurmtce.
AUTHORIZES
signed by the Building OPilClal Or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
Uty; and fees are paid, and receipt is ac-
shnll c eampisted In nlaely days; &IOVED•IN BUILDINGS shall be corn•
pier In eta ..atlu.)
knowledged in space provided.
tlIF TURE (OWNEENT) DATE SIGNED
INSPECTION
DIRT] OR's BIONATU .tom _
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LCITY
DEPARTMENT
/ l i,
OF
ebbIONDS
DAT!•.
NOTE: Applicant Subject to Plan Check Fee
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775-2$28
Tble I'ern,lt r vrr. work to be dmie on Private property ONLY.
Any Construction on fhe publ le dome In (enrbe. old—.1k.. drlY ..y.,
FILE
nuvauree, ete.l .111 re&ulre separate perndsel.n.