750362.pdfr
PERMIT
BUILDING DEPARTMENT Applicant Fill ZONE NUMBER 750362
PERMIT APPLICATION Inside Heavy Lines Of-
Ion 703
NAME (OR NAME OF BUSINESS) ADDRESS
LEGAL LOT LOT ARE SUBDIVISION NO.
❑ YES • ❑ NO _
MAILING ADDRESS
Z )) VARIANCE ORAOB NO.
3 O �,. �1 iG Gc-oto GOND, USE NO. -
G CITY TELEPHONE NUMBER
B
Q PROPOSED YARDS HEIGHT Z I
C•cllLG• %f —�h�� FRONT SIDE REAR Z
NAME Q
ALLOWABLE PROPOSEo -1
U SIGN AREA SIGN AREA e'
W ADDRESS
F OTHER I
= REQUIREMENTS
U
E CITY TELEPHONE NUMBER j
T.+AVALDATENAME REET RI-
STIG STFT. DEFICIENCY THIS PROPERTY
OF ADDRESS COMP. PLAN ST. R%W FT. FT.
iZ CITU TELEPHONE NUMBER REMARKS WZ
F
Z i
O W W
V STATE LICENSE NUMBER CITY LICENSE NUMBER CHECKED BV W
z i
I
Legal Descrlptlon of Property (Show Below or Attach Four Copies) STREET AN TOR UTILITY ❑ YES W
WORK REO'D ❑ NO
UNDERGROUND ❑ YES
ZWIRING REO'D ❑ NO
O _
y/ F TYPE CONNECTION VERIFIED BY
J' L
-u ❑ YES PERMIT NUMBER W
W SEPTIC SYSTEM ?�
U APPVD BY CITY ENG. ❑ NO Id
W
e: REMARKS
W
J METER SIZE SERVICE SIZE CLEARANCE CMECKEO BY
pl
r ; �
REMARKS G I
NEW ® RESIDENTIAL L HE FIRE �Z/O/ TYPE OrF, ONSTR CTION C/'ODE Q % I
r❑r��
ID NON-RESIDENTIAL ❑ SIGN / ll� ,,.Ifs �l 013C 17 / 3
lyl ADD ❑ OCCUPANT
DEMOLISH WALL REOUIREO GROUP LOAD
RETAINING BPECIAL INSPECTOR AREA OCCUPANCY i
EXCAVATE FENCE 13 YES ❑ NO F `
ALTER E]
OR FILL E]I_ %_FTI PLA CHE KED BY THIS SITE IS LOCATED IN THE CITY W I i
OF EDMONEIEDS. LOCAL SALES TAX D
REPAIR ❑ INSP. ❑ pOOL $HDU D
REMARKS =
NUMBER OF STORIES NUMBER OF
DWELLING CL)O „506jac—' —rb -51VC O
UNITS
NATURE OF WORK TO BE DONE m
/ t�sPE�Tlo�1
VALUATION FEE j
PROPOSED USE PLAN CHECK -- !
Z
O NO.
6 PLOT PLAN INDICATE BUILDING SETBACKS, Q
ABUTTING STREETS) BUILDING, d ,
V i I
W PLUMBING
O j
W HEAT & GAS LINE
0
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
i hereby acknowledge that I have reed lhle application; that the In- TOTAL AMOUNT DUE
formation given is correct; and that I am the Owner, or the duly author-
1:ea agent of the Owner. I agree to comply with City and State Iawe re N- ATTENTION
laung construction; and In doing the work authorized thereby, no person APPLICATION APPROVAL
will be employed 1. vioialloO of the Labor Code of the state Of Wuhington THIS PERMIT
rehulog to Workmen'. COmpenaatloa Ioauren—AUTHORIZES This application Is not a permit Until
NOTE: Permit Limit One Year (E.Cept DEMOLITIONS whleh ON LV THE signed d the Building Official r e his Dep-
WOgK NOTED Lt Pac-
She"
✓
shall be Completed In Nasty days; afOVED-IN DDILDINOB Shall be Com- Y; and ices are paid, and receipt is ac-
pletrd In sig ...the.) INSPECTION hnowledged In space provided.
SIGNATURE (OWNER ON AGENT)D/A�TE SIGN�EED OEPARTM ENT DIRECTO 'S SIG T RE
l�lfifl/r">/�J /C2 `rJ �� — /.Li CITY OF
EDMONDS
DATE GG
NOTE: Applicant Subject to Plait Check Fee 775-2525
This Permit covers work to he done on private property ONLY.
Any construction on the pubiie domain (curbs, sidewalks, driveways, ORIGINAL - File YELLOW - Inspeclor
marquees, etc.) will require sepratC permission. PINK - CT'or COLD - .A— - - r
r
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5
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The
Easterly I07 feet measured along
the South line
of the Northerly
II2
feet oP t}i? Snnth�,n..
vn.n s a .,r
— —
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