750118.pdfi
BUILDING DEPARTMENT Applicant FillI
USE PERMIT
ZONE NUMBER ^�
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Inside IleaYy Lines
PERMIT APPLICATION I
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PLUMBING
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OPLOT
NAME R NAME OF BUSINESS)
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PERMI84TLE % TUAL
LOT COVERAGE �C"� OT COVE&AOE f///��
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MAl1.iN0 ADDRESS
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PE1tM 1tle1HLE jiE � T PROPOSED H73T
CITY NUMBERACrUA
/ � O�REA� TOTAL BLDG. AR�(EA,` ,'34
FENCE
REQUIRED YARDS PROPOSED YARDS
NAME
FRONT SIDE REAR FRONT SIDE REAR
S /c7) d.51 4 D' /O '
RETAINING WALL
WADDRESS
LEGAL LOT VARIANCE OR CONDITIONAL USE.
El YES ❑ NO PERMIT NUMBER
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PLANNING I� P.T. PPR VAL _ DATE:
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C CITY TELEPHONE NUMBER L -
SWIMMING POOL
STREET R/W
EXISTING STREET R/ DEFICIENCY THIS PROPERTY L
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NAME
COMP. PLAN ST. R/m . .�.�qy.
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REMARKS Driveway slopes not to exceed those n
PRE -MOVE INSPECTION
ADDRESS
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indicated on Standard Dwq. No.103 OZ
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{U e I l 2 /�11 `"� � r e t
CHECKED BY
F CITY TELEPHONE NUMBER
779
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'DETER BILE SERVICE SIZE CLEARANCE (: D
R i GSI I / 571'
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STATE LICENSE NUMBER CITY LICENSE NUMBER
2�3
Legal Description of Propeerrty (Show Below or Attach Four Copies)
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Ised agent of the owner. I agree to comply With city and state laws regu-
ATTENTION
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TYPE CONNECCTTIION I VERIFIED BY
luting construction; and In doing the work authorized thereby, no Person
PERC. TE8MAIT 14UMBER
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This application is not a permit until
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REMARKS y
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C
.�.7 FIREZONETYPE OF CONSTRUCTION ETRE3➢SPROV ED
/V EB ❑ NO
ONLY THE
WORK NOTED
uty; and fees are Paid, and receipt is ac -
SPECIAL INSPECTOR RREEQUIREDOCCUPANCY .ROUP
YES
I
shall be completed In ninety days; MOVED4N BUILDINGS shall be cam-
RESIDENTIAL GAS
NEW E] LINE
❑ of
pleted In six months.)
PL _GREG D Y THIS SITE IS LOCATED IN THE CITY
❑ NON-RESIDENTIAL❑ SIGN
❑
) OF EDMONDS, HOULD BE CODED AL SALES TAX
INSPECTION
DEPARTMENT
ADD RETAINING
❑ DEMOLISH ❑ WALL
MARK
LDATE
nO 7S
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ElALTER EXCAVATE FENCE
F-1SwIl
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❑ OR FILL (..........z..........Pl.)
❑ REPAIR ❑ MOVE
CITY OF
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N
ElPOOL
_/
/
EDMONDS
NUMBER 0➢ STORIES NUMBER OF
DWELLING
(/V
L�L�y�
NOTE: Applicant Subject to Plan Cbeck Fee
UNITS
/ �./,•�"«��r�/��• /-�lC �7
�G /( C: el/ / �/ 7—LLLQ7%
NATUR OFF, WORK TO BF ONE
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778-252$
Valuation
Fee
Receipt No.
Plan Check No
Any em,nlrnrtlnn nn the Public domain (curbs, MAen'alke, drh'ewaye,
.....................
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F
BUILDING
IIJI-le,?_
1177
PROPOSED USE
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PLUMBING
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OPLOT
PLAN (Indicate Building Setbacks, abutting streets)
HEAT A GAS LINE
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FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this aDPticntlon; that the In-
TOTAL AMOUNT DUE
R i GSI I / 571'
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formation given le correct; and that I sat the owner, or the duty author-
Ised agent of the owner. I agree to comply With city and state laws regu-
ATTENTION
APPLICATION
luting construction; and In doing the work authorized thereby, no Person
APPROVAL
WIII beem played In violation of the Labor Cade of the Slate of Weahlogton
TIUS PERMIT
This application is not a permit until
relating to Workmen's Compensation lueuranee.
AUTHORIZES
signed by the Building Official or his Dep.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are Paid, and receipt is ac -
shall be completed In ninety days; MOVED4N BUILDINGS shall be cam-
knowledged in space provided.
pleted In six months.)
tl IGNA tE (OWNER ORAGE�jT) SIGNED
/ •
INSPECTION
DEPARTMENT
Dl R' 8lGNATU
LDATE
nO 7S
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/
CITY OF
/ - �•-�
EDMONDS
DATE /
NOTE: Applicant Subject to Plan Cbeck Fee
778-252$
This Permit cores Work to be done on private properl ONLY.
Y
Any em,nlrnrtlnn nn the Public domain (curbs, MAen'alke, drh'ewaye,
,., r,Pirr., ,Ir.l „m rreulrr srpuralr i�—.0,eina.
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