740474.pdf0 METER 812E SERVICE SIZE CLEARANCE CHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER
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In
-;
Legal Dceerlptlon of Property (Show Below
BUILDING DEPARTMENT
REMARKS
ZONE "°� R
Lots I and 2, block 39, City of
Applicant Fill
7 q (1474
TYPE CONNECTION
PERMIT APPLICATION
Inside Heavy Lines
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JOB
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Edmonds
11
ADDRESS1008 Main Street
PERC. TEST
PERMIT NUMBER
NAME (OR NAME OF BUSINESS)
(:wcr v i n �lnan
PERMISSIBLE m ACTUAL
LOT COVERAGES LOT COVERAGE
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A �§&
M�� fIRDA
19419 Highway 99
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PERMISSIBLE HEIGHT PROPOSED HEIGHT
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CITY
TELEPHONE NUMBER
ACTUAL LOT AREA TOTAL BLDG. AREA
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Lynnwood, Washington
3CCyy
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
j
REQUIRED YARD" PROPOSED YARDS
YES [] NO
NAME
FRONT BIDE REAR FRONT SIDE REAR
SPECIAL INSPECTOR REQUIRED
GROUP
RESIDENTIAL
GAS
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❑ YES (] NO
IOCCUPANCY
ADDRESS
LEGAL LOT VARIANCE OR CONDITIONAL USE
NEW
i1
LINE
PLAN CHECKED BY
THIS
SITE IS LOCATED IN THE CITY
0 YE8 ❑ NO PERMIT NUMBER
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CITY
TELEPHONE NUMBER
PLANNING DEPT. APPROVAL DATE:
.(
E ADD RETAINING
El DEMOLISH WALL
REMARKS'
SHOULD BE CODED 31.04.
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
El ALTER EXCAVATE ❑
NAME
❑ ORBILLI X..........Fl.)
COMP. PLAN ST. R/W FT.
REPAIR PRE -MOVE SWIM
INSP. � POOL
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REMARKS
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ADDRESS
DWELLING
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UNITS
CHECKED BY
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NATURE OF WORK TO BE DONE
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CITY
TELEPHONE NUMBER
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Fee Receipt No.
Comp I i .nee Inspection
0 METER 812E SERVICE SIZE CLEARANCE CHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER
I
In
-;
Legal Dceerlptlon of Property (Show Below
or Attach Four Copies)
REMARKS
Lots I and 2, block 39, City of
TYPE CONNECTION
VERIFIED BY
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°
Edmonds
11
PERC. TEST
PERMIT NUMBER
n
W
�
REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
j
YES [] NO
SPECIAL INSPECTOR REQUIRED
GROUP
RESIDENTIAL
GAS
E]
❑ YES (] NO
IOCCUPANCY
NEW
LINE
PLAN CHECKED BY
THIS
SITE IS LOCATED IN THE CITY
f
El NON-RESIDENTIAL1:1
BION
OF EDMONDS. LOCAL SALES TAX
E ADD RETAINING
El DEMOLISH WALL
REMARKS'
SHOULD BE CODED 31.04.
El ALTER EXCAVATE ❑
❑ ORBILLI X..........Fl.)
REPAIR PRE -MOVE SWIM
INSP. � POOL
�
I
.l[
NVIIER Ob STORIES NUMBER OF
DWELLING
I
UNITS
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NATURE OF WORK TO BE DONE
Vnluatlon
Fee Receipt No.
Comp I i .nee Inspection
I
Plan Check No.
'
BUILDING
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[°
4 PROPOSED -USEj
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PLUMBING
aPLOT
PLAN (Indleat. Building eetbneke, abutting elrcela)
ItEAT & GAB LINE
h
FENCE
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SIGN
RETAINING WALL
N
iSWIMMING
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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I
25.00
I hereby neknowledge that, [hove rend 161s application; that Ne In•
TOTAL AMOUNT DUE
25.00 13540
'
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 stale law. regu•
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the wont authorized thereby, no person
Will be employed In violation of the Labor Code of the State of Wuhington
THIS PERMIT
This application is not a permit until
relating to workmen's Compen.atlon Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONH whlch
ONLY TIRE
signed by the Building Official or his Dep -
ut and fees are aid, and receipt is ac-
yi P p
.hall be completed In ninety day.; MOVED -IN BUILDINGS Shell he cam.
WORK NOTED
h'nowledged In space provided.
pleted In .I. month..)
SIGNATURE (OWNER OR AGENT)
DATE 81 NNED
INSPECTION
DIREC 'S BIO URE
Imperial Mortgage Co.
8-27-74
DEPARTMENT
CITY OF
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
This Permit r ��en work to bo done on prR•pte property ONLY.
775-2525
I
Any conetrucllon on the nuUllc domain (such.. Adewalk., drlvewys,
ni....... •r, rl r.� ,rill rre .�l rr .elnrnlr prrini+.l.n,
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