750203.pdfBUILDING DEPARTMENT OSNE NUMBS 150203 1
Applicant Fw
PERMIT APPLICATION I Inside Heavy Lines
NAME (oft NAME OF BUSINESS)
���op" A M
m MAILING ADDRESS
197zo 662, -WET
CITY TELEPHONE NUMB1sR
L'i4ri—coo, WssM1 �(,_ Q 13L
NAME
WADDRESS
...—a/ CI
PF.Re118SIBLE/^/ ACTUAL /
LOT COVERAGE' LOT COVERAGE
PERMISSIBLE HEIGHT PROPOSED HEIGHT
ACTUAL LOT AREA TOTAL BLDG. AREA
REQUIRED YARDS PROPOSED YARDS
FF20NT BIDE REAR FRONT HIDE REAR
LEGAL LOT VARIANCE OR CONDITIONAL USE
O YES 0 NO PERMIT NUMBER
C l
l
PLANNING DEPT, APPROVAL DATE:
CITY
TELEPHONE NUMBER
1 -
F
PLANNING DEPT, APPROVAL DATE:
CITY
TELEPHONE NUMBER
1 -
STREET LL/W
EXISTING STREET R/W .......
O
_...FT, DEFICIENCY THIS PROPERTY X
NAME
COMP. PLAN ST. R/W ............FT.
............FT.'.
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5 L F—
REMARKS
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d
ADDRESS
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rLJ
E
CHECKED BY
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NCITY
TELEPHONE NUMDER
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as
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METER SIZE SERVICE SIZE
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CLEARANCE
CHECKED BY
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STATE LICENSE NU51BER
CITY LICENSE NUMBER
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F
REMARKS
Legal Description of Proporty (Show Below or Attach Four Copies)
TYPE CONNECTION
VERIFIED BY
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—�•'
PERC. TEST
PERMIT NUMBER y.
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REMARKS
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FIRE ZONE
TYPE OF
CONSTRUCTION STREET IMPROVED
I
0 YES E3 NO
SPECIAL INSPECTOR REQUIRED GROUP
RESIDENTIAL
OAS
❑ LINE
❑ YES NO
IOCCUPANCY
NEW
13YPLAN CHECKED Y
THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
OF EDMONDS. LOCAL SALES TAX
•,
e1GN
SHOULD OE CODED 31.04.
El ADD
❑o
RETAINING
WALT
REMARKS
DEMOLISH
ALTER EXCAVATE F�j /
Fence requirements - section 12.14.040
❑ OR FILL (.. 3jsm��
REPAIR PRE -MOVE SWIM 40xfeY
INSP. Ej POOL
attached..
NUMBER OF STORIES NUMBER OF
Ij
DWELLING
UNITS
NATURE OF VV7TO HE DONE
Valuation
Foe Receipt No,
Plan Check No .....................
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x
BUILDING
PROPOSED UBE
PLUMBING
U
PLOT PLAN (Indicate Building setbacks, abutting chaste)
HEAT k GAS LINE
O
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
i
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have [end this application; that the In.
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formation given Is correct; and that I alb the owner, or the duly author.
Iced agent ar the owner. I agree to comply with city and .tate laws reg.-
ATTENTION
APPLICATION APPROVAL
,at,.g construction: and in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Wuhington
THIS PERMIT
This application Is not a permit until
'
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOL.ITIONB which
ONLY THE
WORK NOTED
Uty; and fees are paid, and receipt Is ac -
.hall be completed In ninety days; IIOVED•IN BUILDINGS shall be nom•
lcnowledged In space provided.
,
rioted to six menthe.)
SIGNATURE (OWNER OR AGENT)
I DATE SIGNED
INSPECTION_m
DIRECTOR'S BIUNAT R&
�S
DEPARTMENT
L2�, tr U
wES� f� [I�+v.,
71'
C[TY OF
F•'Ii%4 -''?' ,
EDrVIONDS
DATE
NOTE: Applicant Subject to Plan Check Fre
—
775-2525
Tills Permit c work 1, be done on private properly ONLY.
Any Construction an it,. public domain (curbs, sidewalks, drl—sq.,
FILE
marquee., Jr.)a.011 reeulr. separate permission.
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