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BUILDING DEPARTMENT
Applicant Fill
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PERMIT
NUMBER 740446
PERMIT APPLICATION
Inside Heavy Lines
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ADDRE88/
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NAME (OR NAME OF HUBlNESB)
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ACTUAL JJ
LOT COVERAGE
PERalI881BLE 7.
LOT COVERAGE
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PROPOSED HEIGHT �.
PERMISSIBLE HEIGHT
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CITY TELEPHONE NUMBER
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TOTAL B DG.PROPOSEDAA
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FINW 74 -3
YARDS
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FRONTBIDE REAR FRONT BIDE REAR
VARIANCE OR CONDITIONAL USE
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CITY
TELEPHONE NUMBER
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EXIST STREET R/W ............FT.
4-CIENCY THIS PROPERTY
NAME
COMP. PLAN eT. R/W ............FT.
............FT.
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REMARKS
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ADDRESS
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TELEPHONE NUMBER
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ETER BILE
SERVICE SIZE
CLEARANCE
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STATE LICENSE NUMBER
CITY LICENSE NUMBERa
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Legal Descriptionyr of
Property (Shaw Below or Attach Four Copies)
REMAIULS
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CONNECTION
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VERIFIED
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PERC. TEST
PERMIT NUM
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REMARKS
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FIRE] 20NE TYPE OF CONBT�R/U/f1ON ,TREE IMPROVED
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SPECIAL INSPECTORREQUIREDOCCUPANCY GROUP
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RESIDENTIAL
El GAS
❑ YES O.1Q0
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❑ NEW
LINE
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
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El NON-RESIDENTIALSIGN
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OF EDMONDS. LOCAL SALES TAX
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SHOULD 11 CODED 3104
ADD RETAINING
ElDEMOLISH WALL
MAR
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EXCAVATE FE NCE
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ALTER
OR FILL (..........x .......... Ft.)
❑
REPAIR PRE -MOVE SWIM
INSP. POOL
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NUMBER OF STORIES NUMBER OF
DWELLING
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UNITS
WORK TO BE DONE
Valuation
Fee
Receipt N.
�N�1A�TU�RVE[�OF
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.ill
Plan Check N. .....................
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BUILDING
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PROPOSED USE
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PLUMBING
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PLOT PLAN (IndicnI* ➢u1idi16 aclbIIcke, ¢bultln6 streets)
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HEAT & GAS LINE
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FENCE
SIGN
RETAINING WALL
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N
SWIMMING POOL
DEMOLITION
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PRE -MOVE INSPECTION
EXCAVATION OR FILL
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TOTAL AMOUNT DUE
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I hereby acknowledge that I haus read this application; that the In-
formation given Is correet; and that I am the owner, or the duly author-
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Iced agent of the owner. I agree to comply with city and state law. rego.
ATTENTION
APPLICATION APPROVAL
luting conatructlo¢: and In doing the work authorised thereby, no parson
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compen.atloa Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uC and fees are paid, and receipt is ac-
p
.hall be completed In ninety day.; MOVED -IN BUILDINGS shall be com-
Isnowledged in Space provided.
pleteIn .Ix months.)
d
S G ATURE (01V .R OR AGENT)
DATES ONE.
INSPECTION
R. NAT RE
DEPARTMENT
L- 7
CITY OF
NOTE: Applicant Subject to Plan Check Fee
EDMONDB
ATE
�—
775-2525
This Permit covers work to be done on private properly ONLY.
Any eonetnlethm on the public domain (curb,, sidewalks, "l -way.,
i, arnorr., rlr.� „III rrnlu rr neimrulr i�rroueslon.
FILE