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1 BUILDiNG DEPARTMENT AppllcaritFW O 2 S'1�- PERMIT
° HIS` %�� 17
PERMIT APPLICATION _
Inside Heavy Lines ADDREBB I + ,
NAME (OR NAME OF HUBINEBS) r 1 g
r1�y PERMISSIBLE ACTUAL
LOT COVERAGE LOT COVERAGE
{{{qqq MAILING ADDRESS O '
PEIie1188IBLE HEIGHT PROPOSED HEIGHT
k 5-71 4
C CITY I 'ACTUAL LOT AREA TOTAL BLDG, AREA
(/
....... NEy?NUMBER
r Q't+ ✓ I REQUIRED YARDS PROPOSED YARDS
NAME
FRONT HIDE BEAR FRONT BIDF. REAR {
1 l
ADDRESS LEGAL LOT VARIANCE OR CONDITIONAL USE f
eyHl YEB NO PERMIT NUMBER 17
U PLANNING DEPT. APPROVAL DATE:
W CITY TELEPHONE NUMBER
STREET R/W t7
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY :Ly
NAME R
COMP, PLAN 8T. R/W ............FT. ............FT. aWp1I
REMARKS Z
tE ADDREd8
W
' (CHECKED BY
CITY I TELEPHONE NUMBER
2
C METER 812E I SERVICE SIZE I CLEARANCE I CHECHED BY
V STATE LICENSE NUMBER CITY LICE BE NUMBER W
F
REMARKSE
Legal Description or Property (Show Below or Attach Four Cople.) I i /� �I
TYPE CONNECTION �1! I VERIFIED BY
O ,
PERC. TESTPERM3T NUMBER .
i
W REMARKS two
a �1
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED �
C3 YES 0 NO
SPECIAL INSPECTOR REQUIREDGAS
(OCCUPANCY GROUP
YES N
NEW RESIDENTIAL ❑ LINE ❑PLAN CHECKEIOIIYO
THIS SITE IS LOCATED IN THE CITY
ELINON-REeIDENTlAL SIGN Of EDMONDS. LOCAL SALES TAX I
ADD RETAINING REMARKS SHOULD BE CODE.D�131.04.
DEMOLISH WAIT'
ALTER EXCAVATE FENCE
❑ OR FILL � (.......... x ...... ....Ft.) ,/ /nq Q
❑ REPAIR E] INHPPREhSWI
IOVE O POOL /���� PL/./ (/r C, 17 7,3 .� .
NUMBER OF STORIES NUMBER OF
/ DWELLING !
UNITS
NATURE OF WORK TO HE DONE Valuation Fee Receipt No.
Gl FGd-7
, �/3 nn ^^^^ GG flan Cheek N
[: -7Z / 1 T^�r BUILDING QZi 1 0
4 PROPOSED USE
1 a'% PLUMBING
V
aPLOT PLAN (Indicate Building setback., "boiling streets) HEAT d: GAS LINE
h
FENCE
II
BION {
tRETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE 0
1 hereby ncknowledse that I have road this application; that the In-
formn,00
tlon given is correct; and that I am the owner, or the duly author-
Ired agent o1 the owner. I agree to comply with city and state laws reltu- ATTENTION APPLICATION APPROVAL
lalln6 construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code Of the Stale of W"hlUgton THIS PERMIT This application is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep -
ONLY TILE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac -
.hall be completed In ninety day.; MOVED -IN BUILDINGS shall be cont- knowledged in space provided.
pleted In six menthe.)
HIONATURE (OWNER Oft AGENT) DATE B[ONEU INSPECTIONC" t'8 TURE
DEPARTMENT
7.4/ CITY OF
ED51ONDS ATE i
NOTE: Applicant Subject to Plan Check Fee _
775-2525
TUI. Pentut Cal l,.,k to be done on Prls'nle pmPerty ONLY.
Any construction on lips public dental" IeUrb., side.'.", drh'e.'"., FITmaraueee, etc.) .ill reawre .eporals permisslon.