740173.pdfRM
BUILDING DEPARTMENT I ONE NUMBER 740173
Applicant Fill 1
PERMIT APPLICATION I Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
MASLINO ADD SS
CITY TELEPHONE NUMBER
-E� )s
1y NAME
U AD�EJ
JOB
ADDRESS
n
PERMISSIBLE o
LOT COVERAGE
ACTUAL //��
LOT COVEMAOE
V
I-FliMiSSIBLE HEIGHT
PROPOSED HEIGHT
1
i
ACTUAL LOT AREA
TOTAL SLOG. AREA
REQUIRED YARDS
FRONT HIDE REAR
PROPOSED YARDS
FRONT SIDE REAR
STREET R/W
z
1 I
LEGAL LOT VARIANCE OR CONDITIONAL USE
0 YES NO PERMIT NUMSER
_
I
n
V
PLANNING DEPT. APPROVAL DATE:
1
i
3
I
I
I
�
STREET R/W
z
1 I
I
V
PLANNING DEPT. APPROVAL DATE:
1
i
C
CITY TELEPHONE NUMBER
<
STREET R/W
0
1 I
_
EXISTING STREET R/W ............FT.
DEFICIENCY THIS PROPERTY
NAME
COMP. PLAN ST. R/W ............
FT. ............FT.
REMARKS
l
07
LEj
ADDRE88
C
a
CHECKED BY
Pl
CITY TELEPHONE NUMBER
Z
$
I
METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
I
STATE LICENSE NUMBER CITY LICENSE NUMBER
I
a
Legal Description of Property (Show Helow or Attach Four CODIee)
REMARKS
TYPE CONNECTION
VERIFIED BY
,
i
tOr
y
PERC. TEST
PERMIT NUMBER Id
.(
' 1
W
REMARKS
m
q
C
'
i
FIRE ZONETYPE OF CONSTRUCTION STREET IMPROVED
0 YES NO
I
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
CAS
0 YES 0 NO
I f
RESIDENTIAL LINE ❑
NEW
-PLAN CHECKED HY
THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL SIGN
OF EDMONDS. LOCAL SALES TAX
ADD RETAINING
DEMOLISH WALL
REMARKS
cH0 ILD B -COED 3104
ALTER EXCAVATE FENCEf
Section 12.14.040 (fence requirements)
,
❑ OR FILL (...}�...x.
REPAIR PRE -MOVE SWIM
INSP. El POOL
attached.
NUMBER OF STORIESI NUMBER OF
DWELLING
i
UNITS
NATURE OF W
Valuation Fee Receipt No.
t/T(ID/tB�ED,O[NE�
Pian Check No ......................
A
o
BUSLDINC
ty
L
PROPOSED USE
a'fG,
PLUMBING
PLOT PLAN (Indicate Building setbaeks, abutting street.)
HEAT & GAS LINE
!
a
O
PENCE
�f1 n r% � OO
N'C!
SIGN
tRETAINING
WALL
9WIMMINO POOL
I
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I
TOTAL AMOUNT DUE
I
I heresy ackoowletlga that I breva read this nDDllcatlon; that the in•
oC d
formntlon given In correct; and that I am the owner, or the duly author-
I
lzed agent O[ the owner. I agree to comply with city and state laws regu•
ATTENTION
APPROVAL
and
incl., construction; and In doing the work authorized thereby, no person
APPLICATION
will be employed In of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
relating t0 Workmen's Compensation Iaeureace.
AUTHORIZES
'
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
signed by the Building Official or his Dep-
ut and fees are aid, and receipt Is ac -
Y: P P
shall be completed In Nnety days; MOVED -IN BUILDINGS shall be com-
WORK NOTED
]Inowledged LI space provided.
pleled In -Ix months.)
Ixmonths.)
SIGNATURE (OWNER O GE T) DATE SIGNED
INSPECTION
DEPARTMENT
DIRECTOR'S SIONATU "—'-::• ��—r�
C /
CITY OF
EDIIEONDS
DATE
OTE: Applicant Subject to Pian Check Fee
PR ealoy
This Permit coven work to be done On private property ONLY.
Any construction an the public domain (cared, s" walks, driveways.
Marquees, etc.) will require separate, last-.
FILE
I