750162.pdfI -
BUILDING DEPARTMENT Applie6ilt FW USNE S _ 2 PURMIT 750 6 2
PERMIT MAPPLICATION inside HeaYy Linos IGD 3� .CL�t)
ADDRESS
PERh11138IHLE HE f1T PROPOSED HEIGHT 1
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CITY
TELEPHONE NUMBER ACTUAL 5,OT AR TOTAL IIL O A�t EA
l�r�Ov S �9-T
ZS
D YAHO.a�At
REQUIRED YARDH PROPOSED ARDH
E
NAME FRONT SIDE REAR FRONT SIDE REAR
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2- 1045, s
LEGAL LOT VARIANCE O� IONAL USE
W ADDRESS
M W YF.S NO PERhI1T NUMBER
VPDAT
PLAN N PT ROV
al CITY TELEPHONE NUMBER •
'
cc _ STREET R/W
I EXISTING STREET R/W ..........FT. DEFICIENCY THIS PROPERTY
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COhIP. PLAN BT. R/W ...-J... // ..FT. .... .......FT.
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REMARKS O.K. to connect into sanitary sewers
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AD •SS
pL but with no larger line than 2 -inch.
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CHECKED
BY
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C CIT
T/4L£rPB`}O7NE NUMBER
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r/ `�' / ✓ METER BILE SERVICE SIZE CLEARANCE
CHECK D� 8—
STATE LICENSE NUMBER
Cly LICENSE 111111110.d.
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Lnenl --n—,--n—, a[ P--lea �v Below
REMARKS>'+/�
or Attach Foar Ceblee) � J / 1,jr
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YPE rluCONNECTION �VERIFIED BY
f' PERC. ESfi I PERMIT NUMBER
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W REMARKS !�
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0
FIRE 20 TYPE OF CONSTRUCTION STREET IMPROVED
. POOL I 0 YES 0 NO
SPECIAL INSPECTOR REQUIREDOCCUPANCY PfUP
❑ GAS ❑ YES 1KNO
NEW RESIDENTIAL LINE PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
El
NON-RESIDENTIAL SIGN OF EDMONDS. LOCAL SALES TAX
ADD SHOULD BE CODED 31.04.
RETAINING REMARKS
CAV
T WAIT'
E y�M��`� t.�lrr-� ATlpc c0
ALTER ❑ ORCI•R LTE ❑ FENCE
r{y (.......... .......... Ft.) _
REPAIR ❑ PRE -MOVE I iA POOL lZ��� /�� ►'�fC� TS _ E �av0��
NUMBER ON` STORIES NUMBER OF 1 -AL �� Q
DWELLING
UNITS
NATURE OF WORK TO IIE DONE Valuation Fee Receipt No.
Plan Corel, No .....................
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BUILDING
4 I PROPOSED USE
�q PLUMBING
U
PLOT PLAN (Indicate` Building setbacks, abutting streets) HEAT A GAS LINE
\ „/\\c• FENCE
fA,%
SIGN
tRETAINING WALL
SWIMMING POOL.O dO
= DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In. F�v
formation given Is correct; and that I am the owner, or the duly author-
lzcd agent of the oxner. I agree to comply with city and elate laws regu. ATTENTION APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Waehtogton THIS PERMIT
This application is not a permit until !�
relating to Workmen's Compensation lasurance. AUTHORIZES signed by the Building Official or his Dep -
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONH which WORK NOTED uty; and fees are paid, and receipt is ac.
shall be ompleted In ninety days; DIOVED•IN BUILDINGS shall he Som- Imowledged in space provided.
pleteN elx monlbe.)
SIG DATE A' UStE lV "[ I DATE SIGNEU INSPECTION l
"'R1:CTq a 81GNATURE
DEPARTMENT
CITY OF
EDbfONDS ueTL
NOTE: Applicant Subject to Plan Cheek Fre (�
775-2525
This Permlt covers work W be dune on private property ONLY.
Any eoneirneflnn on file Public dnmaln (curbs, elAewNke, driveways,
nl.i nlu rr., •lr.f .rill ,real,, .Ir",a,.• 'Idewl.Nun. FILE
riuuumig traruuil
(Rough)
Frame I J
Furnace & Fuel Lines I
Final
76
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