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NUM IpTR 740504
BUILDING DEPARTMENT Applicant FWZZOSNE
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PERMIT APPLICATION Insido Heavy Lines
JOB
ADDRESS
9 ��
NAM (OR NAME OF BUBIIBB)
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/(./�•61CSWlfYC
PERMISSIBLE 7. ACTUAL
LOT COVERAGE LOT COVERAGE
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MAILING ADDRESS
PERMISSIBLE HEIGHT PROPOSED HEIGHT
CICTYn
TTs"B"HONE "'HER
ACTUAL LOQ AREA TOTAL BLDG. AREA
7.
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-7,7(, ,�V ZV
REQUIRED YARDS PROPOSED YARDS
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NAME
FRONT HIDE REAR FRONT SIDE REAR
F
LEGAL LOT VARI NCE OR CONDITIONAL USE
F
ADDRESS
CA YES [D NO PERMIT NUMBER
4i
PLANNIN D . APPROVAL
LG%Yve
C
CITY TELEPHONE NUMBER
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STREET R/W
C
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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NAME
LAN FT
COMP. PST. R/W ............. ............FT.
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REMARKS
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ADDRESSSj ,f� { (�J,�
o (Oi al J i_ Ak'�
CHECKED BY
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TE-LhlE UVN-E7 NUMBER
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METER SIZE SERVIICCE SIZE CLEARANCE
CHECKED BY
STATE: LICENSE NUMBER
'CITY LICENSE NUMBER
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REMARKS �l
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L.g¢I Deecrlptlon of Property 48how Below or Attach Four Copies)
TYPE CONNECTION
VERIFIED BY
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PERC. TEST
PERMIT NUMBERal
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REMARKS
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FIRE E TYPE O NBTRUCTIpN BTHEET IMPROVED
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✓'�" '/ l N � "a [I NO
NOCCUPANCY
SPhCIAL SNSPECTOR REQUIRED
GROUP
❑ RESIDENTIAL
GAS
❑
❑ YEBNO
n
(�
❑ NEW
LINE
AN
PLCHEC 'D B THIS SITE IS LOCATED IN THE CITY
® NON-RESIDENTIAL
❑ SIGN
OF LOCAL SALES TAXA
DL
❑
U'
SHOULD BE CODED 31.04.
ADD RETAINING
L]❑ WALL
REMARKS
DEMOLISH
E
FEN Cz..........Pl.)PRE-
�/ ` �� ] y /' ,�yJ 7/1/�a �J 2
A—I L GVO/L-'�' Pew- a8c /9/.3
ALTER ❑ OR FILL ❑
❑ REPAIR ❑ INSP. IOVE ❑ POOL
�e°-`-'^'s•r W -/KGs`/ �d� W� G
NUMBER Ok' STORIES NUMBER OF
�Z O
DWELLING jy /I p
/
'
UNITS
NATURE OF WORK TO BE DONE
Valuation
Fee ReceiPt No.
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/yfy.�
Plan Check No.....................
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BUILDING
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PROPOSED UBE
%
PLUMBING
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(T6cy
PLO Tldlog Setback., abutting street.)
HEAT & GAS LINE
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17—
9
FENCE
SIGN
RETAINING WALL
N
_N
,
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledgo fast 1 have read 161. nppllc¢tlan; that Uta In-
TOTAL AMOUNT DUE
�_t�60
Jlo/
formation given iscorrect; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to Comply wlta City and .lata law. regu•
ATTENTION
APPLICATION APPROVAL
laling cone ruction; and 1¢ doing the work authorized thereby, no person
will be employed In violation of the Labor Code or the State of Washington
THIS PERMIT
Tide application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
'
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
uty', and fees are paid, and receipt is ac-
�_-----
.hell he completed In Noety day.; MOVED -IN BUILDINGS shall be cam.
knowledged in space provided.
pleted In mix months.)
BIGNA RE (OWNER OK ENT) DATE SIGNED
INSPECTION
DIRECTOR'S IGNAT
W
J
DEPARTMENT
�t�t^L '" �l-ice .•�_
CITY OF
1'
NOTE: Applicant Subject to Plan Check Fee3
EDMONDS
775-2525
//
Thb Permit Caven work to be done on private property ONLY.
Any construcllan on the public domain (curbs. Sidewalk., drlrewq.'
FILE
mutqueea, rtc.l w1i1 rrqulrC aepnrale Derml.slon.
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