750245.pdfi
BUILDING DEPARTMENT Applicant Flu O RS ;L Kva 82 t 750245
PERMIT APPLICATION Inside Heavy Lines JOB
®�
ADDRESS
NAME (OR NAME OF BUSINESS) � ro
PLRbi1B8IBLE A AL '
LOT COVERAGE �/� /O L.7
O COVEIAGE '' /O T
p' MAI N ADDRESS V D ,
ti`. PER I8 I E HEIGHT PROPOSED HEIGHT O 1
•a ;l1: J b�_ 1.4,1 �� I IS'
CITY TELEPHONE NUMBER ACTUAL LOT AREA TOTAL BLDG. ARE &
% (( ^ I
N�.� _� / �`) U> HEQ REDD ARDS PROP YARDS j
AME FRONT HIDE REAR FRONT BIDE REAR
Iyt�17E 25' '��.'J ) 60' 10 ion'
N A1DDAESB (� �tI/ /� / y LjN3Ey LOT❑ NO PERJANCE RMIT NUMBECONDITIONAL USE i
o D
CITY {/!' ,r/ TELEPHONErNUMSE(H
S 'l 1 T r I 'J/ `/ J J r IT
STREET R/ O
V. (JCJ EXISTING REET R/W ............ FI'. DEFICIENCY THIS PROPERTY
NAME
/ COMP. PLAN 8T. R/W ............ Fr.FT.
i
REMARKS
C, ADDRESS e ^
CHECKED BY
C C1'1'Y TELEPHONE NUMDER 'G
Ne �L� N�J� ��S" etc,Y 7
G METER BILE SERVICE SIZE CLEARANCE CITE XED
STATE LICENSE NUMBER CITY LICENSE NUMBER BY �,�
Legal Description of Property (dhow Below or Attach Fpll[ Copies)
TYPE CONNECTION VE IED BY j, I
TTR�t�F�
�^_ j_7;
PERC. TENT PP MIT NUMBER C
47 a 1- P6,4-1
a REMARKS N
a '
<
v
TYPE OF CQij$ZRUCT1gN STREET IMPROVED
j
a b1RE�7QpiG� /V/—'. /t\,/1
YES "KNO
SPECIAL INSPECTOR REQUIRED OCCUPANCY OROVP
IW -EW LINERESIDENTIAL CAH ❑ YES
'XNO—(
ELAN CHECKED THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL ❑ SIGN 0 EDMONDS. LOCAL SALES TAX
El ADD RETAINING p HO/U�Lp BE CODED 31•.0�/4.0
❑ DEMOLISH WALL [� /. �♦ 1OG/`. //j•��/CI / v�O�I7
ALTER EXCAVATE FENCE ` C� IV a vr� s
OR FILL (.....................Ft.)
REPAIR ❑ INSP.PRE-MOVE El SWII
POOL
NUb]HEI; O!•' STORIES I NUMBER OF
DWELLING
I UNITS
NATURE OF WORK TO HE DONE Vuluntlan Fee Recclnt N
Pion Check Noo.
�i/LFt'-r Sln/(M Jit U {—rfG�jy'.F N
.....................
•r.
o' G
BUILDING ._J t7 •S� 3�'�)) C� -�
a PROPOSED UeE
vi -0 0 1,PLUMBING
A PLOT PLAN (Indicate Building Setbacks, nbatting streets) HEAT & GAS LINE
Jf_�J CiA f�_F D FENCE
SIGN
RETAINING WALL
SWIMMING POO / ]/
DEMOLITION / —c
PRE -MOVE INSPECTION
EXCAVATION OR FILL
17
I hereby acknowledge that I have rend thin application; that the In. TOTAL AMOUNT DUE
I -rival",
ation given is correct; and that I am the owner, or the duly author-
Ized agent of the owner, t agree to comply with city and .tale laws regu- ATTENTION APPLICATION APPROVAL
lating conetructlaa; and to doing the work autharizad thereby,
no Dorean
will bo employed In vlolatlao of the Labor Code of the State of Washington TIHB PERMIT
relating to Workmen's Compensation InsuraThia application Is not a permit until
Insurance. This
ONLY TILE signed by the Building Official or his Dep- i___..----------
NOTE: Permit Limit One Year (Except DEMOLITIONS w•hleh WORK NOTED Uty; and fees are paid, and receipt is ac-
ehall be completed In nlocty days; MOVED•IN BUILDINGS shall be -
pitted lcnowledged In space provided.
d In SIX mon the.)
H10 URE OWNER R AGENT) DAT SIGNED INSPECTION Dl O '8 8 ONAT9
` 1. r / ./ C O — DEPARTMENT /
W �� "j'3"� � -!� �� C jCITY Or
DATE
NOTE: Applicant Subject to Plan Check Fee EDIMOND9
This Permlt covers work to be done on private property ONLY. 775.2525
Any eor t'peuen on um'abut damaln (enrh., .Idrwalkl, driveway..
,•t,•.i wrh Imrr �rl,nratt nr[.,n..l,n,. r•ILh