750173.pdf/MPERM
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BUILDING DEPARTMENT ZONE NUMBE
Applicant Flll R
PERAAI 1 APPLICATION I Inside Heavy Lines
NAM loft NAME qF H�1UBlN ) Jr
a' M�AjILING ADDRESS //
CITY / TELEPHONE NUMBER
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NAME
F ADDRESS —
AdOH J //nnREss
P -H USeIBLE �" p� ACTUAL
LOT COVERAGE e j a,% LOT COVE�AG
PERMISSIBLE HEIGHT GG PROPOSED
AACCPUAL%O; VE `I TOTAL'
REQUIRED YARDS PROF
FRONT SIDE REAR FRONT
LEGAI�LOT { VAR AN: IS7"
[a YES 0 NO PERMIT NUMBER
J
PLANNI 6 D APP P OVAL
CITY
/
TELEPHONE NUMBER
7.
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STREET R { �l yl
EXISTING STREET R/44��y4 .... Fr. DEFICIENCY
COMP. PLAN ST. R/W-llj.�`.!FT. L
PROPOSED
NA
SPECSAL 1N81-ECTOR /REQUIRED
❑ YES
ire'"-
m
GAS
a -RESIDENTIAL
NEN LINE
NON•REBIDENTIAL SIGN
ADD
DEMOLISH1 WALLNING
ALTER EXCAVATE
REMARKS Driveway slopes not t0 El+
A�UsdF
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c
h C) bo x lv Y,
indicated nn Standard nwP_ Nn_
❑
`ENCE�4G
POOL��(✓/
F
CITY
TELEPRONE NUMBER
.77"/-B3'7E.
``tom e�
uas-L�.LD Wwlet�c,-a�i
MID
IUMBER OF STORIES I NUMBER OF
,J DWELLING /
l UNITS
O
y CV (y C7
7ATURE OF WORx TO BE DONE
)
METER SIZE 8ERV3CE SIZE CLEARANCE C:
STATE LICENSE NUMBER
CITY LICENBE NUMBER
Fee
Rccclnl Nn.
?J���
O
FENCE
Plan Check No .....................
I V N
I aj'IES El NO
7.
j
PROPOSED
BUILDING
SPECSAL 1N81-ECTOR /REQUIRED
❑ YES
ire'"-
I OCCUPANCY GROUP
GAS
a -RESIDENTIAL
NEN LINE
NON•REBIDENTIAL SIGN
ADD
DEMOLISH1 WALLNING
ALTER EXCAVATE
✓
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULDECODE31 041:1
?-Ae-—
REPAIR
❑ OR FILL
PRE•MOVESWIM
INSP.
❑
`ENCE�4G
POOL��(✓/
IUMBER OF STORIES I NUMBER OF
,J DWELLING /
l UNITS
7ATURE OF WORx TO BE DONE
PLOT PLAN (Indicate Building Setbacks, abutlln6 Blree[s)
Valuation
Fee
Rccclnl Nn.
Plan Check No .....................
+
7.
PROPOSED
BUILDING
�� � • ""
��
t
USE
aPLUMBINGt�u`
PLOT PLAN (Indicate Building Setbacks, abutlln6 Blree[s)
HEAT k GAB LINE
riQG
d
O
FENCE
I
SIGN
tRETAINING
WALL
--
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
/ G
I hereby acknowl<dga that I have rend this application: that the in.
TOTAL AMOUNT DUE
formation given ie correct; and that I am the owner, or the duly author-
tzed agent of the owner. I agree to comply with city and .tate law. reg..
luting construction; and In doing the work authorized theroby, no person
ATTENTION
APPLICATION APPROVAL
will be employed In violation of the Labor Code of the Stale of Washington
THIS PERMIT
This application 1s not a permit until
relating to Workmen's Compensation Insurance.
.AUTHORIZES
ONLY THE
signed by the Building Official or his Dep-
--
�--^
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
uty; and fees are paid, and receipt Is ac -
.bell be comparted In ninety days; MOVED -IN BUILDINGS shall be wm•
knowledged in space provided,
plcted In eI. menthe.)
�)
IM-1—NA TLE (L�ER7GE aDATE STONES
/
INSPECTION
DEPARTMENT
''
1 S SIONATU E
CITY Or
NOTE: Applicant Subject to Plan Check Fee
EDAiONDB
DATE
ZI
775-2525
This Permit coven work to be done an private property ONLY.
Airy cones ruellmt nn the public dmm.ln (enrb,, sidewalks, drlymrayn,
rtrJ 1,11, r Inln . .on r VrnuhHnn
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