740300.pdfI
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PERMITUSE
740300
BUILDING DEPARTMENT Applicant Flu
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PERMIT APPLICATION Ineldo Heavy L►noe
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ADDRESS�/
NAME (OR NAME ON BUSINESS)
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PERMISSIBLE
PLOTER
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C/ t� 10 Al"e C.
COVERAGE
LOT COVE&AGE
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MAILING ADDRE88
PEItl.11HSI8LE BRIGHT
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PROPOSED HEIGHT y_
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FZR7
C TY TELEPHONE NUMBER
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ACTUAL LOT AREA
TOTAL BLDG, AREA
Q 7e-- �1
REQUIRED YARDS PROPOSED YARDS W
NAME
FRONT SIDE
REAR FRONT HIDE REAR
777
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LEGAL LOT VARIANCE OR CONDITIONAL USE
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ADDRESS
YES NO PERMIT NUMBER
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PLANNING DEPT. APPROVAL
DATE:
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CITY TELEPHONE NUMBER
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STREET R/W
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EXISTING STREET A/W ...........,FT.
DEFICIENCY THIS PROPERTY
NAME
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COMP. PLAN ST. R/W ............FT.
REMARKS
............FT.
W
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ADDRESS
w
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CHECKED BY
CITY
TELEPHONE NUMBER
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METER SIZE SERVICE SIZE
CLEARANCE
CHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER
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REMARKS
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Legal Description of Property (Show Below or Attach Four Copies)
TYPE CONNECTION
BY
1
O
(VERIFIED
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-FERC. TEST
PERMIT NUMBER
y.
W
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m
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REM RKS
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FIRE ZONE I TYPE OF
CONSTRUCTION BTREET IMPROVED
YES ❑ No
SPECIAL 1NBPECTOR REQUIRED
OCCUPANCY GROUP
-
AS
�� RESIDENTIAL LINE
YES NO
❑ ❑
I
NEW
PLAN CHECKED BY
THIS SITE 15 LOCATED IN THE CITY
El NON-RESIDENTIAL ❑
Of EDMONDS. LOCAL SALES TAX
SIGN
SHOULD BE CODED 31.04.
ADD RETAINING
REMARKS
❑ DELISH WALL
ALTER EXCAVA E FENCE
`
OR FILL - (..-.......x.......... Ft.)'
REPAIR PRE'INSP. El swif
.'
❑ POOL
NUMBER OF STORIESI NUMDER OF
DWELLING
UNITS
i
NATURE OF WORK TO BE DONE
Valuation
Fee Receipt No.
LL
mei mil Af �o�U ;iJO/ h4 Plan Cheek Na
.....................
BUILDING
4 PROPOSED
USE
PLUMBING
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A PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT &GAB LINE
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FENCE
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SIGN
tRETAINING
WALL
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SWIMMING POOL
DEMOLITION
PRE-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this aPPII=tlon; that the in-
form¢"on given le correct; and that 1m athe owner, or the duly author-
(zed agent of the owner. I agree to comply with city and slate laws res,ATTENTION
APPLICATION APPROVAL
IaUng con.lrucllon; and In doing the wares authorized thereby, no Person
will be employed to Wolntl¢n of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
t
relating to Workmen'. Compeneatlon I¢surance.
AUTHORIZES
Signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Eicept DEMOLITIONS which
ONLY TILE
WORK NOTED
utyi and fees are paid, and receipt is ac-
,hall be completed In maety days: MOVED-IN BUILDINGS shall be mm-
knowledged in space provided.
pleted In six months,)
SIGNAT RE (OWNER OR AGENT) DATE B10NED
INSPECTION
DEPARTMENT
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CITY OF
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EDMONDS
DAT
NOTE. Applicant Subject to Flan Check Fee
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775-2525
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Thls Permit etre work to he done on private properly ONLY.
Any construction on the public domain (curbs, sidexalks, driveways,
mnequees, etc.) will require separate permission.
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