750050.pdf�~'—art...
•" __...r-.�_,
------
'`---------
t
i
BUILDING DEPARTMENT
E
ONE
PERM
NUMBER /JUDO
t
I
Applicant FID
�/
PERMIT APPLICATI01�
Inside Heavy Lines
JOB
ADDRESS
+'{
NAME (OR NAME OF BUSINESS)PFRI
64,
•�
-Ro
,.
ACTUAL J
N A L i �V
L PLA lei
LOT COVERAGE
LOT COVERAGE
LOT COVERAGE
MAILING ADDRESS
L,4
PERMISSIBLE HEIGHT
PROPOSED HEIGHT
'
(/O to - sq fE�2
w�-
O
CIITY
TELEPHONE NUMBEY R/
ACTUAL LOT AREA
TOTAL BLDG. AREA
,'L
',
1
/^1
/- '✓ / �ra S
('j
7 S-- 3'Y I&
PROPOSED YARDS
^
REQUIRED YARDS
NAME
FRONT SIDE
REAR FRONT SIDE REAR
FLEGAL
ADDRESS
LOT VARIANCE OR CONDITIONAL USE
(3 YES 0 NO PERMIT
NUMBER
jl
D
U
PLANNING DEPT. APPROVAL - DATE:
CITY
TELEPHONE NUMBER
STREETR/W
t7
EXISTING STREET R/W ..........FT.
DEFICIENCY THIS PROPERTY
NAME
COMP. PLAN ST. R/W ............FT.
............FT.
i
REMARKS
{w
R7
C
ADDRESS
O
..
o
x
w
j
e�
8Y
F
CITY
I TELEPHONE NUMBER
(CHECKED
r
G
O
METER SIZE
SERVICE SIZE
CLEARANCE
CHECKED BY
I
STATE LICENSE NUMBER
CITY LICENSE NUMBER
41
I
REMARKS
'I
Legal Description of Property (Show Below
or Attach Four Copies)
I
TYPE CONNECTION
VERIFIED BY
i
o
it
PERC. TEST
PERMIT NUMBER
6,
n
±
I
R£1IARKB
en
1
�I
O
i
i1
.i
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
�
YES 0 NO
SPECIAL INSPECTOR REQUIRED
GROUP
OAS
❑ YES [3 NO
IOCCUPANO_
NEW
RESIDENTIAL
LINE
PLAN CHECKED BY
THIS
SITE IS LOCATED IN THE CITY
- -
NON-RESIDENTIAL
� axcN
OF EDMONDS. LOCAL SALES TAX
-
ADD
RETAINING
REMARKS
SHOULD BE CODED 31.04.
DEMOLISH
WALL
ALTER EXCAVATE
FENCE
Fence requirements - section 12.14.040
OR FILL
CC
C..f.. V.l.....Fl,)
REPAIR F� INSPRSWIM
❑ SSWM
POOL
attached.P.
F
NUMBER OF STORIES NUMB
R OF
.I I
DWEL
1N6
UNITS
NATURE OF WORK TO BE DONE
Valuation
Fee Receipt No.
Plan Check No .....................
j
BUILDING
t
[o
W
PROPOSED USE
l
aPLUMBING
PLOT PLAN
(Indicate Building setbacks,
abutting streets)
HEAT & GAS LINE
j
FENCE
O
SIGN
RETAINING WALL
-
_
------..___��.._.
N
jr 'i t I
,�
SWIMMING POOL
.
'r '� .•i /{" C'
DEMOLITION
<,
1
PRE -MOVE INSPECTION
EXCAVATION OR FILL
,
T
•-��-
TOTAL AMOUNT DUE
1 hereby aeknowtedga that I have read
this application; that the In-
[ormatlon glean Is correct; and that I era
the owner, or the duly author-
ized agent of the owner. I agree to comp
'Y with city and state laws regu-
ATTENTION
APPLICATION APPROVAL
lating—Aructlan; and In doing the wa
k authorized (hereby, no Par—
will be employed In vlolatlon of Ne Labor
Coda of the State at Washington
THIS PERMIT
This application is not a permlt until
relating to Workmen's Cnmpsnaauan Ina
ranee.
AUTHORIZES
'
NOTE: Permit Limit One Year
(Except DEMOLITIONS which
ONLY TRE
WORK NOTED
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac -
shall be completed In ninety days; MOVE114N
BUILDINGS shell be win.Wledged
in Space provided.
In six months.)
UltE (OWNER OR AGENT)
CNA UltX (OWNER OR AGENT)
DATE B16NE0
DATE SIGNED
INSPECTION
INSPECTION
DI TO O TU E
DEPARTMENT
-
-�
7-7
CITY OF
NOTE: Applicant Subject]
to Plan Chcck Fee
EDAIOND$
DA E
775-2525
This 1'rrmlt cavern work to be done
on prlvate Property ONLY.
7
Any conelnleUon on the pubilc domain
(earbn, nmewniks, drh'ew'RSa,
r
• elc.l .•III e,lal rr
1111110
e1�LLro1i• p„rou r.lon.
FILE
�R
-
Ai+
E