740622.pdfr I
., ; ... `.PERMIT
V
RESIDENTIAL
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BUILDING DEPARTMENT AppLC811t FW ZONrE NUM13ER 740622
1,
NON-RESIDENTIAL I
PERMIT APPLICATION I Insldo Heavy Llneg JOB
ADDRESS
NAME (OR NAME OF BUSINESS)
rJ� o l ACTUAr
F< K LOT COVERAGE LOT COVE`YAOE
a
II
ADD
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❑
RAWA,IfnNC
MAILING ADDRESS
PER\I1dSIDLE HEIOIIT PROPOSED HEIGHT
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C ITY ,, j ` ,
k-lAfv WQO i
TELEPHONE /NUMBER ACTUAL LOT AREA TOTAL BLDG. AREA
-7 - Ll4 REQUIRED YARDS PROPOSED YARDS
EXCAVAT E
❑
NAME FRONT SIDE REAR FRONT BIDE REAR
I.,
¢Uj
H
VARIANCE OR CONDITIONAL USE
(ENCs..........Fl.)
ADDRESS LEGAL LOT
YES [:I NO PERMIT NUMBER
pj
PLANNING DEPT. APPROVAL DATE:
FENCE
CITY TELEPHONE NUMBER
cc
STREET R/W
I EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
O
POOL
IUIIBER OF STORIES
NUMBER OF
NAME
W ^ ' � �I COMP. PLAN ST. R/W ............FT. ....._ .....FT.
L% Pj �!\ REMARKS
W
41
I04
4
/
7(
F
ADDRESS
CHECKED BY
z
I
CITY
I TELEPHONE NUMBER
I
METER SIZE I SERVICE SIZE I CLEARANCE I
I •.
CHECKED BY
I
F1NEW
RESIDENTIAL
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Li_z x:—t t AI 1 ) (/UiO 69'�•�t'q,Li-_L- �D I' I
D
Q
NON-RESIDENTIAL I
❑
SIGN
❑
ADD
❑
DEMOLISH
❑
RAWA,IfnNC
PLUMBING
ALTER
EXCAVAT E
❑
PLAN (Indicate Building setbacks, abutting streets)
❑
On FILL
(ENCs..........Fl.)
REPAIR
PRE.MNSP.
FENCE
❑
O
POOL
IUIIBER OF STORIES
NUMBER OF
I
DWELLING
9tVIMMINO POOL
DEMOLITION
UNITS
FIRE Z9DI£ I TYPE
SPECIAL INSPECTOR
O YES -A3 NO
ET IMPROVED
YES 0 NO
GROUP
•ATED IN THE CITY
LOCAL SALES TAX
Valuation Fee Rccel pt No.
Li_z x:—t t AI 1 ) (/UiO 69'�•�t'q,Li-_L- �D I' I
D
1 -OM
Plan Check No,_ ..................
BUILDING
�/'I A
O
OW .015 /0,00
{O
G PROP0 ED UBE
r V
PLUMBING
aPLOT
PLAN (Indicate Building setbacks, abutting streets)
NEAT A GA9 LINE
B
0
FENCE
SIGN
RETAINING WALL
I
9tVIMMINO POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have rand lhte aDDllcntlen; that the In.
formation given Is correct; and that I "the owner, or the duly author-
Ired agent of the owner. I ngree to comply with city and .tale laws regu-
lating con. Mellon: and m doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Stale of Washington
THIS PERMIT
This application is not a permit until
retailing to Workmen's Compensation Insurance.
AUTHORIZER
ONLY TILE
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (E—Pt DEMOLITIONS which
WORK NOTED
uty; and fees are paid, and receipt isac-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be Com•
llnowledged In space provided.
;
pleted in els months.)
SIGNATU ION It OR AG T) DA E Bl NEU
INSPECTION
DEPARTMENT
DIRECTOR' NAT E
C
CITY OF
�~
NOTE: Applicant Subject to Plan Check Fee
EDMONDS
DATE
%iF 7
775-2525
Permit ..oyer trork to be dons on privateproperly ONLY.
Any
Any constrnetlon nn the public J¢maln (..orbs, M...... n, drlrewaye,
FILE
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