740440.pdfBUILDING DEPARTMENT
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NUMBER 740440
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PERMIT APPLICATION
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side Heavy Lined
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ADDRESS
NAME (OR NAME OF BUSINESS)
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IAT COVERAGE
LOT COVERAGE?
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PROPOSED HEIGHT
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TELEPHONE NUM
ACTUAL LOT AREA
TOTAL BLDG. AEA
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REQUIRED YARDS
PROPOSED YARDS
NAME
FRONT BIDE
REAR FRONT SIDE REAR
ADDRESS
YES LOT❑ NDITIONAL USE
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(] NO PERMIT BER
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PLANNIN DER% A DOVAL DATE:
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STREET R/W
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NAME
EXISTING STREET R/W ............FT.
DEFICIENCY THIS PROPERTY
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PLAN ST. R/W ............FT'.
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REMARKS
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ADDRESS
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CHECKED BY
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TELEPHONE NUMBER
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METER SIZE SERVICE SIZE
CLEARANCE
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STATE LICENSE NUMBER
LICENSE NUMBER
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Legal Description of Property ISheW Below/or
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REMARKS
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TYPE CONN ON
VERIFIED BY
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PERC. TEST
I PERMIT NU t ER
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FIRE ZONE TYPE OOFCOCTION T IMPROVED
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PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
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NON-RESIDENTIAL
SIGN
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OF EDMONDS. LOCAL SALES TAX
ADD RETAINING
El DEMOLISH WALL
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SHOULDBE CODED 3104
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OR FILL
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REPAIRPRE-MOVE
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NUMBER OF BTORIE9NUMflER OF
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NATURE OF WORK TO BE DONE
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Fee Receipt No.
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PI20PO8ED USE
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DEMOLITION
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PRE -MOVE INSPECTION
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EXCAVATION OR FILL
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I hereby acknowledge that I have reed this application; that the In.
TOTAL AMOUNT DUE
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formation given 1s correct; and that I nm the owner, or the duly author-
Ized agent of the owner. I aRree to comply with city and stale Inmos raga-
Iating conetructloo; end In doing the work authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
will be employed In violation of the Labor Code of lbs State of Washington
relating to Workmen's Compensation Imurance.
THIS PERMIT
This application 1s not a permit until
NOTE: Permit Limit One Year
AUTHORIZES
ONLY THE
signed by the Building Official or his Dep-
(ExceptDINshallDEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be mom-
WORK NOTED
uty; and fees are paid, and receipt is ac-
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pizled In mix months.)
knowledged In space provided.
1,11ONATURL (OWNER OR AGEN15-1
DATE SIGNED
INSPECTION
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DEPARTMENT
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CITY OF
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EDMONDS
ATE
NOTE: Applicant Subject to Plan Check Fee
775-2525
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This Permit rovers work to be done on private property ONLY.
Any construction on ilia public domain (curbs, sidewalk., driveways,
nmrqurrr, rlr.l "III rn•aSepnntle prrmL Ston. _
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