740546.pdf,r
RESIDENTIAL
GAB
LINE
❑ YES Q.NO
`
❑ ADD
ALTER
ElDEMOLISH
NON-RESIDENTIAL
EXCAVATE
s1GN
RETAINING
��� WALL
It J/"ENCE
OF EDMONDS. LOCAL SALES TAX
SHOULD eE CODED 31.04.
ARKS
Fence requirements - section 12.14.040
i
❑ OR FILL I��—I (..........x..........Fl.)
REPAIR
EJ
PRE-hIOVE
INSP.
1
attached.
IUMBER OF STORIES
NN5TIEROF
SIGN
RETAINING WALL
BUILDING DEPARTMENT
Applicant FID
ZONE
NUBS13ER 740546
SWIMMING POOL
PERMIT APPLICATION
Inside IleaVy Lines
PRE -MOVE INSPECTION
Me
ADDRESS
EXCAVATION OR FILL
LOT CVPERMISSIBLE 7
LOT COVERAGE
! jf
ACTUAL q
LOT COVERAGE
I
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1 hereby acknowledge lhnt I have read this application; that the In.
NAME {OR NAME OF BU81NER8)
I4J) IIA rYt �- ( U
x �� y�
OL
X
� I
-
M MA -11 ADDRESS
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PEIt5318e1BLE HEIOlIT PROPOSED HEiORT
M D YI (`' i I 'U(,�
TELEPHONE NUMBER
D �r
ACTUAL LOT AREA TOTAL BLDG. AREA
REQUIRED YARDS PROPOSED YARDS
BIDE REAR FRONT BIDE REAR
NAME
THIS PERMIT
This application Is not a permit until
relating to Workmen's Compensation Insurance,
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{.. /0l /' /�'1 r
1
NOTE: Permit Limit One Year (Except DE51OLITIONS which
ONLY THE
WORK NOTED
`
yUj ADD 'B8
N
5Qe—
LEGAL LOT VARIANCE OR CONDITIONAL USE
YE8 C3 No PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
CITY
NACM�E, %NI
C
d ADDRESS
FO
!U
4 CITY
F
7
O
U STATE LICE
Legal Descrl
O
J
b
W
STREET R/1V p
EXISTING STREET R/W ............FT, DEFICIENCY THIS PROPERTY
LAN ST. R/W ............FT. ............
REMARKS FT.
NO
NEW
RESIDENTIAL
GAB
LINE
❑ YES Q.NO
PL CKED DY THIS SITE 15 LOCATED IN THE CITY
❑ ADD
ALTER
ElDEMOLISH
NON-RESIDENTIAL
EXCAVATE
s1GN
RETAINING
��� WALL
It J/"ENCE
OF EDMONDS. LOCAL SALES TAX
SHOULD eE CODED 31.04.
ARKS
Fence requirements - section 12.14.040
❑ OR FILL I��—I (..........x..........Fl.)
REPAIR
EJ
PRE-hIOVE
INSP.
8M5E
POOL
attached.
IUMBER OF STORIES
NN5TIEROF
SIGN
RETAINING WALL
DWELLING
N
SWIMMING POOL
DEMOLITION
(r
Pian Check Nn ........ _............
BUILDING
e, PROPOSED USE
PLUMBING
O
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT d: GAS LINE
O
.�,
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
} d_
1 hereby acknowledge lhnt I have read this application; that the In.
OL
formation given le correct; and that I am the owner, or the duly nuthor-
Ired agent of the owner. I agree to comply with city and slate taws regu.
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no person
x•111 be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application Is not a permit until
relating to Workmen's Compensation Insurance,
AUTHORIZER
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DE51OLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac -
shalt he completed In ninety days; MOVED -IN BUILDINGS shall be com-
knoWledged ace provided.
pleted T six months.)
SIGNATUIIE (OIVNER OR AGENT) DATE SIGNED
INSPECTION
IRE R' SIGN TURF
DEPARTMENT
t v
CITY OF
—DATA
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
/Q '
775.2525
This Permit raven work to be done on private property ONLY.
Any constructlnn nn the put dmm�in Icnrbs, sidewalks, drWews.ys,
FILE
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