740090.pdfBUILDING DEPARTMENT Applicant OU ONE NUMBER 740090
PERMIT APPLICATI®II Imide Heavy Line ,oH
/NAME (OR NAME OF BUSINESS) ADDRESS to D
/`e PERMISSIBLE gCTUAL
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PERMISSIBLE HEIGHT PROPOSED HEIGHT / / l7
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T O NUMBER
ELN D)n �( 7 (p �� S S
ACTUAL LOT AREA TOTAL BLD.. AREA
REQUIRED YARDS 1'ROPoBF.D YARDS
NAME
FRONT BIDE REAR FRONT 875E REAR
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ADDRESS
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LOT VARIANCE OR CONDITIONAL USE
NO PERMIT NUMBER I",
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CITY TELEPHONE NUMBER
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NAME
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E%IST1 STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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REMARKS
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ADDRESS
CHECKED BY
CITY
TELEPHONE NUMBER
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METER SIZE SERVICE SIZE CLEARANCE
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STATE LICENSE NUMBER CITY CENSE NUMBER
Legal Description of Yro rty (Snow Below r Attach Four Copies)
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REMARKS
TYPE CONNECTION VERIFIED BY
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PERC. TEST
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REMARKS
FIRE ZONE I TYPE OF CONSTRUCTION IST�REE�gET IDtPROVED
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ePEC3AL INSPECTOR REQUIRED OCCUPANUY GROUP
RE8IDENTIAL GAB
NEW LINE
NON-RESIDENTIAL El SIGN
❑ YES (�. I _rte/
PLAN CHECKED DY THIS SITE 19 LOCATED IN THE CITY
(��-/� / OF EDMONDS. LOCAL SALES TAX
ADDElRETAINING
DEMOLISH� WALL
ALTER EXCAVATE FENCE
YA �CS SHOULD B CODED 31 ,04.
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OR FILL (....................Ft.)
❑ ❑
REPAIR PRE -MOVE SWIM
INSP. POOL
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NUMBER OF STORIES NUMBER OF
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DWELLING
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UNITS
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NAT21J F OIiK TOBEDRONE
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Valuation Fee Receipt No.
Plan Check No.. ...................
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PROPOSED USE
BUILDING
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PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT h GAS LINE
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FENCE
SIGN
RETAINING WALL
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etVIMMIN6 POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby ackoowledss that I have read ttus application; that the in.
formation given is correct; and that I am the owner, or the duly author-
ired agent of the owner. I agree to comply with city and state laws ragu-
Ialtn I construction; and In doing the work authorised thereby, co person
TOTAL AMOUNT DUE C
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ATTENTION APPLICATION APPROVAL
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will be employed In vloleuloa of the Labor Code of the State of Washington
relating to Workmen's Compensation Inauranos.
NOTE: Permit Limit One Year (Eicept DEMOLITIONS which I completed
shall bmoely days MOVE62N BUILDINGS shall 6e win.nowegen
pletcd n sl months.e.
TIDE PERMIT
AUTHORIZES This application is not a permit until
ONLY TILE signed by the Building Official or his Dep-.----
WORK NOTED Uty; and fees are paid, tired receipt l9 6C -
kldd in space provided,
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tl1ONAT (OWNE DATE BIGNED
INSPECTION IRE B e NA URE
DEPARTMENT 77
CITY OF
N014- Applicant Subject to Plan Check Fee
EDMONDS DATE
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Thin Permit vero work be done en private prowrty ONLY.
Any construction an the public domain (enrbe, eld,walk., driveway.,
PR g-1107
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