750134.pdfPERMIT APPLICATION I Inside Heavy Lines
I NAME (OR NAME OF BUSINESS)
AJJL_ ley
MAAfIILLINGG .ADDRESS { �j
0
CITY TELEPHONE NUMBER
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NAME
W ADDREtle
ADDRESS
JOB �D
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PERk11SeIDLE
ACTUAL
LOT COVERAGE���
LOT COVERAGE
PERMISSIBLE HEIGHT
PROPOSED HEIGHT
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mss/
ACTUAL O�T A
OARa PTOTAL
t 4c� APPeeox
REQUIRED YARDS
PROPOSED Y S
FRONT SIDE
REAR FRONT HIDE REAR
o2a' S ' i dd-� s
LEGAL LOT VAR ANCE OR CONDITIONAL USE
® YES NO PERMIT NUMBER
F
JPLANNING DE T. PROV AL _7eATE;
CITY TELEPHONE NUNHER y
STREET R/{V ,
EXISTING STREET R/ DEFICIENCY THIS PROPERTY
NAM 1�COMP. PLAN ST. RP64 L9F1'.
ADDRESS R....O...FT.
EMARIIS Driveway slopes not to exceed those
indicated on Standard Dwg. No. 103
1` ltT--H'IV CHECK BY
F CITY TELEPHONE NUMBER
NETF:R 12E 18E<�3CE SIZE I CLEARANCE 0�i Y C /
G STATE LICENSE NUMBER CITY LICENSE NUMBER //
flan Check N. .....................
FIRE ZONETYPE OF CONSTRUCTION STREET IMPROVED
01
n
3 Yq
W
NO
v
W
-1
flan Check N. .....................
FIRE ZONETYPE OF CONSTRUCTION STREET IMPROVED
01
BUILDING
3 Yq
NO
SPECIAL INSPECTOR REQUIREDOCCUPANCY
❑ YES P4.-
PLUMBING
GROUP
I I
It GAB
NEW LINE
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
1—RETAINING
E] ALTER
NON-RESIDENTIAL I
DEMOLISH
E] EXCAVATE
OR FILL
[:]
�
E]FENCE
SIGN
WALL
(.......... x .......... Ft.)
F Ai
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
Q /;
HEAT & GAS LINE
REPAIR PRE -MOVE
Imap.
al
SWIM
POOL
r�J G/�J`d �CUI
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YUNIIER-OF STOItiE9 NUMBER OF
FENCE
DWELLING
SIGN
Z
UNITS
—_T
N
NATURE �OF�
jYORK TO EE DONE
a i i k I G
Vnluntlon
Fee Receipt No.
flan Check N. .....................
01
BUILDING
3 Yq
PROPOSED USE
PLUMBING
G �'
aPLOT
PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
al
FENCE
SIGN
•
RETAINING WALL
—_T
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
1
_
TOTAL AMOUNT DUEGQ-
I hereby scknowledge that I heve read this application; that the In.
tormntlan given Is correct: and that I sur, the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and stale law. regu-
ATTENTION
APPLICATION APPROVAL
leting construction; and In doing the work authorized thereby, no penon
will be employed In violation of the Labor Code of the Slate of Washington
THIO PERMIT
This application is not a permit until
relating to Workmen's Compensation Insuranee.
AUTHORIZER
signed by the Building Official or his Dep-
i
NOTE: Permit limit One Year (Except DEMOLITION8 which
ONLY THE
{YORK NOTED
ut and tees are paid, and receipt is ac-
yi P
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
knowledged In space provided.
r
pleted 1n six menthe.)
HIGNATURE (OWNER OR AGENT) DATE H30NEU
INSPECTION
Dim C OR' SIGNATURE
DEPARTMENT
CITY OF-
EDIIIONDB
DATE '
TE: Applicant Subject to Plan Check Fee
t � �_
This 1•ermlt c n cork to be sone on private property ONLY.
775-2525
Any c ... trnetinn nn the public domain (curbn, nldewnikn, drh'ewaye,
irniir., rlr.i „III rrl i�l rr eepnrnlnrrinleelnn.
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