740436.pdfBUILDING DEPARTMENT DBE PERMIT
Applicant Filt ZONE �S--�j NUMBER
PERMIT APPLICATION I Inside HGLVy Linea dos
� ADDRESS 5 ��
NADIE (O E OF BUp1NEbb)
ACTUAL
PERISSIBLE
/_ /YiS w..O LOT ACOVERAOEe LOT COVERAGE
Eb
E
FRONT BIDE nEAR FRONT
BIDE REAR
S 1
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LE At, LOT VARIANCE: OR CONDITIONAL
USE
0 YES NO PERMIT NUMBER
NEW
PLANNING DEPT. APPROVAL
DATE:
STREET R/LV
PLUMBING
EXISTING STREET R/W ...._......FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT.
............FI'.
REMARRB
NON-RESIDENTIAL
[
CHECKED HY
� PLOT PLAN (Intlleate Building eetbaeke, abutting e[raete)
METER BILE
I BERVICfl SIZE
I CLEARANCE
CHECRED HY
REMARKS
N A
ADD
�6—
/'J/A
❑ YES ❑ NO
GROUP
ICATED IN THE CITY
LOCAL SALES TAX
Plnn Cheek No .....................
DUILDIN6
ElRESIDENTIAL
[]
LINE
❑P
NEW
PLUMBING
LANS
❑
NON-RESIDENTIAL
[
� PLOT PLAN (Intlleate Building eetbaeke, abutting e[raete)
HEAT & GAS LINE
SIGN
®
ADD
❑
Ej
ylALL KING
REltA]
SIGN
DEMOLISH
TRETAINING
WALL
ALTER
CTE
❑
PEN
❑
ORFIIL
x..........Ft.)
REPAIR
❑
PRE-INSP.
El
SWIM
_
IUMBER OF STORIES
NUMBER OF
EXCAVATION OR FILL
I DWELLING
❑ YES ❑ NO
GROUP
ICATED IN THE CITY
LOCAL SALES TAX
Plnn Cheek No .....................
DUILDIN6
E.Ei
E PROPOSED UBE
PLUMBING
k
� PLOT PLAN (Intlleate Building eetbaeke, abutting e[raete)
HEAT & GAS LINE
21
FENCE
SIGN
TRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
0
I hereby acknowledge that I have read this application; that the In-
formation Riven Ie correct; and that I em the owner, or the duly author-
ized agent of the owner. I agree to comply with city and stele law" regu-
ATTENTION
APPLICATION APPROVAL
lating conetructlon; and In doing the work authorized thereby, no person
trill be employed In violation of the Labor Cade of the State of Wmhington
THIS PER5IIT
This application 1s not a permit un
reinting to Workmen's Carepeneatlon Ineurance.
AUTHORIZES
eigned by the Building Official Or his D(
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is t
.11¢11 be completed In nl¢ety days; BIOVED-IN BUH,DINGS shall be co n-
knowledged in space provided.
pleted In eIx manth".)
SIGNATURE (OWNER Olt AGENT) DATE SIGNED
INSPECTION
DIRE
B S ♦ RE
a9
DEPARTMENT
•-�
CITY OF
EDMONDS
DA•,
l•
NOTE: Applicant Subject to Plan Check Fee
"~
775.2525
fe
Thle 1'lrnrlt !ar'enwork to be done an Private property ONLY.
•
Any construction on the public domaln (curbs, .Idewdk., driveway.,
FILE
mnrqu!!.. etc.) will require elparate Perml..len.