750137.pdfZ
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BUILDING
DEPARTMENT AppllesuJvtyFL1nea
PERMIT APPLICATION I Inside Hea
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USE PERMIT-750137
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PERMISSIBLE
LOT LOT COVE}IAGE
MAILING ADDRESS
PERMISSIBLE HEIGHT 1'ItOPOSED 1IEIOFiT
CITY
TELEPHONE NUACTUAL
aREQU.RED
LO A O TOTAL DI.Ua. AREA
YAIiDd PROPOSED YARDS
FRONT SIDE HEAR FRONT BIDE REAR
NAME
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ADDRESS
LEGAL LOT VARIANCE itCONDITIONAL USE
YE8 NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
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CITY
I TELEPHONE NUMBER
STREET/1
EXISTING STREET R/W ...........FT. DEFICIENCY THIS PROPERTY
NAME
COMP. PLAN ST. R/W ............FT. ............FT.
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ADDRESS
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I CHECHED BY
CITY
TELEPHONE] NUMBER
METER SIZEI
SERVICE 812E CLEARANCE
CHECKED BY
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WC
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
REMARKS
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Legal Description of Property (Show Below or Attach Four Copies)
TYPE CONNECTION
VERIFIED BY
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PERO, TEST I
PERMIT NUh1HER
REMARKS 'T6
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Fl TYPE OF CONSION 1 STREET IMPROVED
�..I/ `%�J' ❑ YES [I NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
❑ YES ❑ NO
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GAB
RESIDENTIAL ❑ LINE
❑ NEW
NON-RESIDENTIAL sICN
ADD vEDEMOLISHATAAi-N.
❑ ALTER ❑ OFILL EXCAVATE ❑ FENCE
❑ REPAIR ❑ PRE-MOVE F1SwillI
INSP. POOL
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OP EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS _
�F�-101�1 F•iRJ K, YAVsT �l.
�L:. M�{l 1. '/ Or� RLL�� •
NUMBER OF STORIES NUMBER OF
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DWELLING
UNITS
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NATURE} OF WORIK TO (BE( DONE l �`'}{ �� { '7-t� l'�j
DL=-mo L^1 J/,/ I/4� U 0 11V ! (? 1 A'r3 e
Plnn Checic No.....................
Valuation
Fee
Recelpt
No.
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BUILDING
PROPOSED USE _
PLUMBING
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PLOT PLAN (Indicate Building setbncke, nbutting etreete) HEAT &CAB LINE
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C FENCE _
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S'JiZL)CTUR-6SIGN
D{OLiSiI '
RETAINING WALL I
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I eWIMMIN6 POOLNT
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L : DEMOLITIONr 00,
PRE-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
thereby acknowledge that I have read this aDpllcntlon; shut We In-�S
,Hon given 1. correct; and that I ace the owner, or the duly author-
Ixed agent of the owner. I agree to comply with city and state law. reg.- ATTENTION APPLICATION APPROVAL
Jahns ConetructIon; and In doing the work authorized thereby, no person
will be ,played In violation of the Labor Code of the Slate of Waebinglon THIS PERMIT This application is not a permit until
relallag to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
shell be completed In ninety days: MOVED-IN BUILDINGS shall be wm- knowledged In space provided.
Pleted In six menthe.)
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SI ATURE IVNE OR ///��� ENT) DATE SIGNED INSPECTION DIRECT 'S SIGNATUR
I " DEPARTMENT /A,/J->��•d71"
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CITY OF DATE*{
EDBIONDS
NOTE: Applicant Subject to Plan Check Fee
775-2525
This P—nit r cork to be done as prlvale properly ONLY.
Any eonetrurUml on it.. public domain (curbs, sidewalks, driveway., FILE
marquees, etc.) will require separate permis.lon. '