740438.pdf—.
BUILDING DEPARTMENT Applicant Fill
USE
ZONE
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PERMT
NEMHILR 740438
PERMIT APPLICATION I Inside Heavy Line.
JOB
ADDRESS
(OR NAME OF BUSINESS)
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DNAME
PERMISSIBLEV
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MAILING AUDREBB
LOT COVERAGE
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3 1019 S�RR!IL;
PERMISSIBLE HEIOHT / PROPOSED REIOHT C
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CITY
TELNUM^BER
ACPUA LOT,( RIEA '
TOTAL BLDG. AREA
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RMQ I11//RED YARDS PROPUSFefD YARDS
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NAME
FRONT BIDE
REA FRONT SIDE, REA
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LELOT VARIANCE
OR CON ITIONAL USE
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ES 0 NO i P/ RMIT NUMBER
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CITY TELEPHONE NUMBER A nG
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EXIBTIN STREET R/W
............FT, . DEFICIENCY THIS PROPERTY/
NAME
COMP. PLAN ST. R/W
............FT. ............FT.
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REMARKS
REMARKS
7
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ADDRESS
CHECKED BY
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CITY
TELEPHONE NUMBER
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SIZL -SERVICE SIZE CLEARANCE
CHECKED BY
STATE LICENSE NUMBER
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TY LICENSE NUMBER
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Legal Description o[ Property (Show HelaW or Attach Copies)
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T h c. N/ c St hal P ,P L o t 3-3
T PCONNECTION
VERIFIED BY
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PERC. TEST
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REMARKS
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.1 FIRE ZONE ONS31, 1E IMPROVED�
[3 NO
SPECIAL INSPECTOR •QUIRE.
GROUP
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RE.IDENTIAL GAS
❑
❑ YES O
(OCCUPANCY
/
LINE
NEW
PLAN CHECKED Y
THIS SITE IS LOCATEDIN THE CITY
❑ SIGN
OF EDMONDS. LOCAL SALES TAX
H ULD B CODED 31,04.
ADD RETAINING
DEMOLISH WALL
ARK
ALTER EXCAVATE FENCE
OR FILL <.........3..........Ft.)
❑ ❑
SWI
REPAIR ❑ INei'MOVE
POOL
Of�i.�.7_G_
V!l �N cS/'a �/1eJ� C//d�v�
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NVD[DER OF BTORI EHI NUMBER OF
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DWELLING
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UNITS
NATURE OF WORKO D
HE ONE
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Valuation Fee Receipt No.
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Pion Check No .....................
F
BUILDING
PROPOSED USE
7 ��
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PLUMBING
aPLOT
PLAN (Indicate Bullding Setbacks, abutting street.)
HEAT & GAS LINE
FENCE
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I I X AI
SIGN
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RETAINING WALL
N
ISWIMMING
POOL
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DEMOLITION
PRE -MOVE INSPECTION
Niib'
EXCAVATION OR FILL
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TOTAL AMOUNT DUE
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I hereby acknowledge that I have react fill. application; that the In-
forma lion given Is correct; and that I am the owner, or the duly author -
(zed agent of the owner. I agree to comply with city and elate laws regu.
toting construction: and In doing the work authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
will be employed In violation of the Labor Code of the Stale of Washington
THIS PERMIT
is
This application is not a permit until
permitun
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed p-��---
the Building Official his
NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY TIIE
Dty; and fees is
to be completed In ninety days; MOVEU-IN BUILDINGS Shall be com-
WORK NOTED
are paid, and receipt ac-
knowledged In space
ple
plated In six months.)
ixmonths.)
provided.
81GNATUItE (OWN^LR OR AGED�T) DATE STONED
INSPECTION
D
DEPARTMENT
NA U
Cr ,/
I
CITY OF
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
Thee Permit r -ark to be done on private property ONLY.
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775-2525
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