740573.pdfTYPE CONNECTION
1
C4 RESIDENTIAL
BUILDING DEPARTMENT
Applicant Fill
USE E PERMIT R 740573
NEN
0..
REAMARKB
LINE
PERMIT APPLICATION
Insido Heavy Linos
JOB
❑
SIGN
PLAN CHECKED DY
THIS SITE 15 LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHO LD BE CODED 3104
ADDRESS
REMARK.
RETAINING
WALL
/
ALTER
NAME (OR NOE; OF B INEae/
Pion Cheek N. .....................
Valuation Fee Receipt No.
BUILDING
❑ ORFILL
❑
CENC........... Ft.)
ThPermit c cork lu be done en Private properly ONLY.
le k
IS87HLE J
PEUAL
LOT COVERAG? T COVE G
I,
,I
1
POOL
F
O
M 1LINU ADDRESS
Ag.
C
PERMISSIBLE HEIGHT PROPOSED HEIGHT x
CIT /�/,/(_
rK 1b)- il-.••
TELEPHONE NUMBER
ACTUAL, LOT AREA TOTAL BLDG. AREA ,'4
I,
REQUIRED YARDS PROPOSED YARDS
NAME
FRONT BIDE REAR FRONT BIDE REAR
W
!Y.
j
ADDRESS
LEGAL LOT VARIANCE OR CONDITIONAL UeE
0 YES NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
CITY
TELEPHONE NUMBER
;•. -
O
STREET R/W
EXIBTIN6 STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAAAjjJr��LE
COMP. PLAN ST. R/W ............FT. ............FT.
',
W
REMARKS
a
p[+
O
^ I�
p I
I�
ADDRE
absat�
C
'^
TELEPHONE NUMBER
_131ZE11
CHECKED BY
(
STATE LICENSE NUa16ER
I CITY LICENSE NUMBER
METER SIZE
BLRVICE CLEARANCE
I CHECKED BY
Legal Dtecripllon or Property (Shaw Below or Attach Four Coplee)
REaSAlIHS
TYPE CONNECTION
SIGN
C4 RESIDENTIAL
El
CAS
NEN
0..
REAMARKB
LINE
M
m
ADD
NON•REeIDENTlAL
❑
SIGN
PLAN CHECKED DY
THIS SITE 15 LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHO LD BE CODED 3104
❑ DEMOLISH
REMARK.
RETAINING
WALL
/
ALTER
EXCAVATE
Pion Cheek N. .....................
Valuation Fee Receipt No.
BUILDING
❑ ORFILL
❑
CENC........... Ft.)
ThPermit c cork lu be done en Private properly ONLY.
le k
REPAIR
❑ INSP.EOVE
❑
POOL
(UMBER OF BTORtEB NU�IDER OF
I DWELLING
TYPE CONNECTION
SIGN
VER"ED BY
RETAINING WALL
PERC. TEST
I PERMIT NUMBER
0..
REAMARKB
DEMOLITION
M
m
FIRE ZONE I TYPE OF CONSTRUCTION STREET IMPROVED
0 YES 0 NO
NOTE: Permit Limit One Year (Except DEMOLITIONS
SPECIAL INSPECTOR REQUIRED I OCCUPANCY GROUP
0 YES 0 NO
which
shall be completed In Nasty day.; IIIOYE -IN BUIL DINOS shall be Com-
PLAN CHECKED DY
THIS SITE 15 LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHO LD BE CODED 3104
REMARK.
INSPECTION
/
DEPARTMENT
Pion Cheek N. .....................
Valuation Fee Receipt No.
BUILDING
EDMONDS
NOTE: Aliplicant Subject to Plan Check Fee
PLUMBING
HEAT & GAS LINE
FENCE
ThPermit c cork lu be done en Private properly ONLY.
le k
775-'2545
Any stunt rurllonOn the Public tlnmalnsidewalks, drh'en•ays,
ni.krvin ��•�. rt r.l �•'llt rrn nick .rparntc p,•rmi�rlan,
U^ -
V
I hereby acknowledge that I have read thla application; that the In-
SIGN
formation given Ia correct; and that I am the owner, or the duty
RETAINING WALL
N
lacing construction: and In doing the work nuthorlxed thereby, no person
SWIMMING POOL
will be employed In violation Of the Labor Code of the Stale of Wa-hi.gton
DEMOLITION
rotating to Workmen's Compensation Insurance.
PRE•MOVE INSPECTION
NOTE: Permit Limit One Year (Except DEMOLITIONS
EXCAVATION OR FILL
I hereby acknowledge that I have read thla application; that the In-
TOTAL AMOUNT DILE
formation given Ia correct; and that I am the owner, or the duty
agent of the owner. I agrte to comply With city and atate laws rag.-
lacing construction: and In doing the work nuthorlxed thereby, no person
ATTENTION
will be employed In violation Of the Labor Code of the Stale of Wa-hi.gton
TIDE PERMIT
rotating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS
ONLY TILE
which
shall be completed In Nasty day.; IIIOYE -IN BUIL DINOS shall be Com-
WORK NOTED
Pitted In six month-.)
IIGNA�/L/- (OWN AGENT/' DATE StONEU
INSPECTION
/
DEPARTMENT
CITY OF
EDMONDS
NOTE: Aliplicant Subject to Plan Check Fee
ThPermit c cork lu be done en Private properly ONLY.
le k
775-'2545
Any stunt rurllonOn the Public tlnmalnsidewalks, drh'en•ays,
ni.krvin ��•�. rt r.l �•'llt rrn nick .rparntc p,•rmi�rlan,
VAN
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, find receipt is ac-
knowledged In space provided.
DIH/F OR's SIGNATURE
r,
DATE
7
FILE