750283.pdfC ..
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ZONE NU BIRMMBER 750283
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BUILDING DEPARTMENT
PERMIT APPLICATION
Applicant Fill
Inside Heavy Lines
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NAME' (OR NAME OF BUSINESS0
ADDRESS O L" ,tib
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LOT COVERAGE A
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MAILING ADDHE88
COVERAGE
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PERMISSIBLE HEIGHT PROPOSED HEIGHT
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CITY
TELEPHONH NUMBER
ACTUAL LOT AREA TOTAL BLDG. AREA
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NAME
REQUIRED YARDS PROPOSED YARDS
FRONT BIDE REAR FRONT BIDE REAR
LEGAL LOT VARIANCE OR CONDITIONAL
ADDRESS
USE
0 YES E3 NO PERMIT NUMBER
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CITY
TELEPHONE NUMBER
PLANNING DEPT. APPROVAL r DATE'.
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BTREHT A/N
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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COMP. PLAN ST. R/W ............FT. ............FT.
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REMARKS
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CHECKED BY
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CITY
TELEPHONE NUMBER
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METER BILK,
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SERVICE SIZE CLEARANCE
CHECKED BY
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
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Legal Description of Property (Shaw Below or Attach Fa.r Copley)
REMARKB
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TYPE CONNECTION
VERIFIED BY
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PL•RC. TEST
PERMIT NUMBER
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FIRE TYPE OS COy$TiiUCTIr l STREET IMPROVED
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/I�-/1 ❑ YES 0 NO
SPECIAL INSPECTOR REQUIREDOCCUPANCY GROUP
RESIDENTIAL GAS
- ❑ LINE
NEW
❑ YES C
PLAN CHECKED I
BY
THIS SITE IS LOCATED IN THE CITY
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NON-RESIDENTIAL El[] SIGN
ADD
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
RETAINING
DEMOLISH WALL
REMARKS
0 ALTER EXCAVATE FENCE
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11kAj �^ A -Al—f S�ueTO4
OR FILL (-.........x..........Ft.)
REPAIR ❑ P SPhfOVE ❑ POOL
f�.YG�, /"(J y rev
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NUMBER OF STORIFs I NUMBER OF
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DWELLING
UNITS
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NATURE OF WORK TO HE DONE
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Valuation
Fee Receipt No.
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Pion Check No....................
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BUILDING
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PROPOSED UBE
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PLUMBING
oil
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PLOT PLAN (Indicate Building .ettmeks, abutting .tracts)
HEAT A GAS LINE
PENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE-MOVE INSPECTION
EXCAVATION OR FILL
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TOTAL AMOUNT DUH
I hereby acknowledge that I have read this application; that the In.
formation given Is correct; and that I am the owner, or the duly author.
Ized agent of the owner. I agree to comply with city and elate Tawe reg._
leting ca..truclmn; and In doing the work authorized thereby, no Derean
ATTENTION
APPLICATION APPROVAL
Will be employed In violation of the Labor Coda of the State of Washington
relating to Workmen's Compensation Insurance.
THIS PERMIT
This application is not a permit until
.
NOTE: Permit Limit One Year DEMOLITION
AUTHORIZES
ONLY TH
signed by the Building Official or his Dep-
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(Except which
.hall be completed In ninety days; MOVED-IN BUILDINGS .hail be coin•
WORK NOTED
uty; and fees are paid, and receipt Is ac-
pleled In six months.)
kllowledged In apace provided.
SIGNATURE (OWNER O A NT)
INSPECTION
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LIL—,
DEPARTMENT
DIRECTOR' !GNAT H
CITY OF
NOTE: Applicant Subject to Plan Check Fee
EDDiONDS
DATE C
This Permit covers work to ho done on private property ONLY.
775-2525
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, ete.) will require separate Permiselnn•
FILE
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ASSESSED VALUATION
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LA'.D BUILDINGS. TOTAL
GINE
AL.-, SPECIAI'i
66,240 500 66,740
1,,663.63'
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SCHOOL DISI RICT-
POR
DISI RICT
O1HER, T
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26A.6S
921.41
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?5 PI(%•L
1 t r kd
`1 t�
•ill
SEWER
FOREST FIRE
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NO.
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Trq r vA3LETO:
191,
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1A.54 �`
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(NOHOMISH COUNTY TREASURER !- �YsiQ 1�4y
EVERETT, WASHINGTON 96206 REAL ESTATE TAX STATEMENT
COUNTY, STE OF WASHINGTON:,
SNOHOMISH
OF l.LL STATE. COON V. MUNICIPAL.-_:-
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SCHOOL, AND R AD TAXESa fU;
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ASSESSED VALUATION
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LA'.D BUILDINGS. TOTAL
GINE
AL.-, SPECIAI'i
66,240 500 66,740
1,,663.63'
_-1
- _, 6E CISTRIBUi ED TO THE FOLLOWING TAX DISTRICTS:
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CITY :,R ROAD/ LIB,
SCHOOL DISI RICT-
POR
DISI RICT
O1HER, T
J_ i �1 i5
26A.6S
921.41
?5 PI(%•L
WATER
SEWER
FOREST FIRE
DIKE
NO.
DRAIN NO
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