750281.pdfa
BUILDING DEPARTMENT Applicant FILL
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PERMIT APPLICATION IBalde Heavy Linea
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NAME (OR NAME OF BUSINESS)
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PERAfISBIBL 7
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UAL
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MAILING ADDRESS
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PERMISSIBLE HEIGI
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CITY TELEPHONE NUMBERF%
ACTUAL LOT AREA
TOTAL BL
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REQUIRED YARDS
PROPOSED YARDS
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NAME
FRONT SIDE
REAR FRONT BIDE REAR
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2,s 3�' /3 Ups'
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ADDRESS
LE LOT VARIANCE
ES NO PERMIT
OR CONDITIONAL U8E
NUMBER
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CITY TELEPHONE NUMBER
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STREET R
EXISTING REET R/W
............FT. DEFICIENCY THIS PROPERTY
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NAME
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COMP. PLAN ST. R/W
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REMARKSADDRESS
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CHECKED BY
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CITY'
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TEIIIEPB NE NUMBER
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STATE ICENSE NUMBER
CITY LICENSE NUMBER
METER SIZE
I SERVICE
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SIZE
CLEARANCE
I CHECKED BY
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223-051 - 1 le 2 �tb'
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Legal D�e./aI/cr�lpllon a ply (Shaw .clow .1 AAItt/nchh Four Coplee)
REMARKS
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TYPE CONNECTION
VERIFIED
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PERU. TEST
PERMIT NUMBER
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REMARKS.
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FIRE Z TYPE, OF CONSTRUCTION STREET IMPROVED
YES
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LST•
L] NO
SPECIAL INSPECTOR REQUIRED OCCUPAN(.�OROUP
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® RESIDENTIAL
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GAS
❑ YES No NO
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NEW
LINE
PLAN CHECKED
THIS SITE IS LOCATED IN THE CITY
NON_RESIDENTIAL
SIGN
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OF EDMONDS. LOCAL SALES TAX
ADD RETAINING
HALL
SHOULD BE CODED 31 04
REMARKS
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❑DEASOLISIi
ALTER EXCAVATE FENCE
OR FILL (..........z..........Ft.)
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1 3,3
ElREPAIR PRE -MOVE SWIM
INSP. POOL
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NUMBEROF STORIES NUMBER OF
DWELLING
OL,'Y
, UNITS
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NATU
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Valuation
Fee
Receipt No
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Plan Cheek N. .....................
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PROPOSED
BUILDING
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PLUMBING
PLOT PLAN (Indicate Building setback., ab"tttng e,,!,a)
HEAT & GAS LINE
FENCE
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SIGN
RETAINING WALL
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SWIMMING POOL
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DEMOLITION
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PRE -MOVE INSPECTION
EXCAVATION OR FILL.
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TOTAL AMOUNT DUE
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I hereby acknowledge that I have rend this application; that the In.
rormMlon given Is correct: fund that I sun the owner, or the duly nulhor-
leed agent of the owner. I agree to eomplY with city and state laws reg"-
.ming conetruetlon; and In doing the work nuthorlaed thereby, no person
ATTENTION
APPLICATION APPROVAL
will be employed In violation of the Labor Code of the state of Wmhmgton
relating to Workmen's Compensation Insursnee.
THIS PERMIT
This application 19 not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit limit One Year (Except nF.AtOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac.
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
knowledged In apace
pleted In elz months.)
provided.
SIONATUI(L OWNER OR ENT) DATE SIGNED
INSPECTION
DIRE OR'B BI A HE
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DEPARTMENT
�-
CITY OF
NO L•: Applicant S:I jto Plan Check Fee
EDDIONDS
/
DATect
This Permit covers work lu be done on private property ONLY.
775-2$25
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Any canelructlnn an Iho pubilc domain (curbs• sldewnlNe, driveways.
u+. ry,u+v. rt r.) ++'ill rrnol rr erl'itrnlr pr ml�+l„n. _
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