750295.pdfBUILDING DEPARTMENT Applicant FW °NE PERMIT 750295
PERMIT APPLICATION
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ADDRESS43
NAME (OR NAME OF DUBINEBB) qq
G LOT COVERAGE. LOTUCOVEHtAOE
m A[LI ADDREBtl /j /,
PERMISSIBLE HEIGHT PROPOSED HEIGHT OZ
O CITTYA' ACTUAL LOT AREA TOTAL BLDG. AREA
TELEPHONE NUMHk.R
7 6 REQUIRED YARDS PROPOSED YARDS
NAME FRONT SIDE REAR FRONT BIDE REAR
NADDRESS ' YEB LOT❑ NO PERMIT N1.UMBER NDITIONAL USE
PLANNING DEPT. APPROVAL DATE:
CCITY TELEPHONE NUMBER I -
! STREET R/W p
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME ...........FT. W
COMP. PLAN BT. R/W ............FT.
RDMAHICB ti
C ADDRESS x I
RESIDENTIAL -1 LINE
NEW ❑ NON-RESIDENTIAL SIGN
ADD ❑ DEMOLISH ❑ WALL
ArNG
LL KI
I'D
ALTER F-1ORCFILL EXAVATE C/JrcA......
J...Ft.)
WIM
REPAIR F-1IPREP. ❑ pOOL i
IUMBER OF STORIES NUMBER OF
DWELLING
UNITS
FIRE ZONE I TYPE OF CONSTRUCTION I 8TREET IMPROVED
O YES [3 NO
SPECIAL INSPECTOR REQUIRED I OCCUPANCY GROUP
0 YES 0 NO
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
NATURE OF WORK'I'lY E D�Ory En
Valuation
Fee Receipt No.
-.ri t^—t-moi
Plan Check N. .....................
BUILDING
PROPOSED UBF
PLUMBING
O
a
PLOT PLAN (Indicate Building aMback., abutting streets)
HEAT A GAB LINE
i
9
O
FENCE
car
BIG"
RETAINING WALL
N
SWIMMING POOL
DEEIOLITION
I '
PRE -MOVE INSPECTION
EXCAVATION OR FILL
1
TOTAL AMOUNT DUE
I hereby acknowledge that I have read t61s application; that the In.
Ol
�
lormatlon given in correct; and that I are the owner, or the duty author-
Ise. agent of the owner. I agree to comply with city and .tele law. reg.-
ATTENTION
APPLICATION APPROVAL
I I
lating construction; and 1n doing the work authorized thereby, be p.r.on
will be employed In violation of the Labor Code of the State of WoshlDgton
THUS PERMIT
This application is not a permit until
relating to Workmen's Compensation Inturenw.
AUTHORIZES
signed by the Building Official or his Dep-
"�--
NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY TItE
WORK NOTED
uty and fees are paid, and receipt is ac-
.hallbe completed In ninety days; MOVED -IN BUILDINGS shall be win-
hnowledged in space provided.
pleted In cin month..)
SIGNATURE OWNER OR AGENT
( )
DATE SIGNED
INSPECTION
DEPARTMENT
D3 TOR'.. BlONAT RE � „� Ir �•e
�r
at..- Zrl
In
CITY OF
. (..,(�/�'/'�,
EDMOND$
DAIfE J
NOTE: Applicant Subject to Plan Check Fee
775-2525
Thle I'rnnit r ark to I" donr on private property ONLY.
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