750327.pdfUSE PERMIT
BUILDING DEPARTMENT Ap illmnt FW ZONE NUMBER 750327
PERMIT APPLICATION Ineldo Heavy Lines JOB $ 3/�
ADDRESS
NAME (OR NAME OF BUSINESS
/ (�J LOT C VERA ACTUAL J
/ l/f�(/� ��„�•/�F <'�- LOT COVERAGE LOT COVERAGE {
N MAILI a ADDRESS
RESIDENTIAL
❑
S
EJNEW
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PERMISSIBLE HEIGHT PROPOSED HEIGHT
CITY �
LINE
TELEPHONE NUMBER
ACTUAL LOT AREA TOTAL SLUG. AREA
NON-RESIDENTIAL
❑
SIGN
REQUIRED YARDS PROPOSED YARDS
FRONT 8IDE REAR FRONT BIDE REAR
NAME
kFC
O
WA�AIIMNG
ALTER
WADDRESS
DEMOLISH
EXCAVATE
❑
LEGAL LOT VARIANCE OR CONDITIONAL USE
O YES NO PERMIT NUMBER
N
❑
ORFILL
PLANNING DEPT. APPROVAL DATE:
NUMBER
CITY
INEP1110VE
TELEPHONE
STREET R/{V
IU1I86R OA' STORIES
NUMBER OF
RETAINING WALL
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME
DWELLING
I
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
W ADDRESS
0
SWIMMING POOL
7 TUItE OF WORK TO BE DONE
I CHECKED BY
U
NCITY
TELEPHONE NUMBER.
r
I
u
EXCAVATION OR FILL
METER SIZE I SERVICE SIZE I CLEARANCE
CHECKED BY
n
RESIDENTIAL
❑
S
EJNEW
�
O
t
'I
LINE
,
O
NON-RESIDENTIAL
❑
SIGN
❑ ADD
❑
kFC
O
WA�AIIMNG
ALTER
O PLOT PLAN (Indlenlo ➢ulitlin6 setbacks, abutting Streets)
DEMOLISH
EXCAVATE
❑
PEN C.
❑
ORFILL
.......... Ft.)
REPAIR
❑
INEP1110VE
❑
swill
IU1I86R OA' STORIES
NUMBER OF
RETAINING WALL
DWELLING
I
UNITS
SWIMMING POOL
7 TUItE OF WORK TO BE DONE
DEMOLITION
/
r
n
Ilan Check No .....................
S
Z
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t
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kW
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,
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Z
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kFC
Valuation
sr_
Ilan Check No .....................
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BUILDING
PROPOSED USE
�4
l
PLUMBING
O PLOT PLAN (Indlenlo ➢ulitlin6 setbacks, abutting Streets)
HEAT k GAS LINE
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the 1n-
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 stale Inwe reg'
ATTENTION
APPLICATION APPROVAL
InUng construetlon; and In doing the work authorized thereby, no Derean
will be employed In violation of the Labor Code of the Slate a1 Wwhinglon
THUS PERMIT
This application is not a permit un
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his De
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
Uty; and fees are paid, and receipt Is a
mile]) •I
be completed In ninety days; aIOVEDN BUILDINGS hall be -,a-
knowledged in space provided.
pieted In mix menthe.)
SIGNUJtE (OWNER OR AGENT)/
j
DATE SIGNED
INSPECTION
DEPARTMENT
DF OR'S 816NATU
1 r%
----,
CITY OF
EDMONDS
DAT
NOTE: Applicant Subject to Plan Check Fee
This Permit col'ere work I' be don an private property ONLY.
775-2525
Any conururtlall on the public domain (curbm, eldewelke, dri-way.,
,i�. rm�rrr. rir.) �, III r,nniri• ."past. n...... mlun.
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