750213.pdfI
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PERMIT APPLICATION I Iniad Heavy Lines
NAME (OR NAME OF BU82NE8..
G 6DA40N05
MAILING ADDRESS f�
CITY ,r I _74Z:11
/ Z:EJZS/
ADDRESS 2QOy7'O/j
_
ST.
PERMISSIBLE %
IAT COVERAGE
ACTUAL
LOT COVERAGE n�
PERN38SIBLE HEIGHT
PROPOSED' H'EIQR/TT/
6�]^,A
ACTUAL LOT AREA
TOTAL BL
REQUIRED YARDS
FRONT e1D
PROP SED YARDS
REAR FRONT BIDE REAR
01 h N
K) N /4
LEGALOTn NO PERIANC. 1111
RMIT NUMBERN 17j[GIQAj/1I7 E
STREET R/etTY p
EXIeTINO REET R/W ..(�........FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W SU-, .....V....FT,
!C r REMARKS
' 714 — /LI —✓" \ • .,5 I CRECKED t
TELEPPHONE NUMBER
r D � METER SIZE 1 SERVICE SIZE 1 CLEARANCE I CHECKED BY
9
FIRE Z_111P�
/A
/J! A
TOTAL AMOUNT DUE
.I—V—
10 YES 0 NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
RESIDENTIAL
ATTENTION
GAB
LINE
will be employed In violation or tae Labor Code of the Slate or Washington
'AND
❑ YE8 ANO
I F'-" I
relating to Workmen's Compensation Insurance,
NOTE: Permit limit Ono Year (Except DEMOLITIONS which
ehnll be completed In ninety day.; MOVED -IN BUILDINGS shall be com•
AUTHORIZES
ONLY TI[E
WORK NOTED
signed by the Building Official or his Dep -
uty: and fees are paid, and receipt is ac.
knowledged I.space provided.
pleled in sli months.) .
II 1,AT R' OWN O AGENT) DATE, IONED
(
\
INSPECTION
DEPARTMENT
"LA.
THIS SITE IS LOCATED IN THE CITY
NOTE: Applicant Subject to Plan Check Fee
NON-RESIDENTIAL
❑
DATE ^ f /
Till. Permit rUYere work to be I... on private property ONLY.
OF EDMONDS. LOCAL SALES TAX
FILE
BION
SHOULD IIE CODED 31.04.
ADD
DEMOLISH
RETAINING
WALL
REMARKS
y
U/ry ' ( � 73
ElALTER ❑ EXCAVATE
on FILL
FENCE
(..........z..........Ft.)
ALL
REPAIR PRE -MOVE
INSP.
SWIM
POOL
f 1''•a�
���7�'�'1F�C
NUMBER OF STORIES NUMBER ON466E66
/ DWELLING,7���'`
6V
&Z—
)U�
�/m4
UNITS
/�-� ;
r
NATURE O''F11 WORK T�O� BEDODONE
Valuation Fee Rece
GO/lust /JW
/ U. ,�
/
e /
Plan Check N. .....................
� SLdk l� G AAJO/0Y
BUILDING
E
ZAN
PLUMBING
PLO(Indicate Building setbacks, abutting directs)
HEAT & GAS LINE
q
FENCE
SIGN
—_
RETAINING WALL
N
—
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
[ hereby acknowledge that I have road t61e application; that the In-
formotl.n given le correct; =4 that I ann the owner, or the duly author -
lied ¢gent of the owner. I agree to comply with city and .late laws rag, -
laling construction; end In doing the work authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
will be employed In violation or tae Labor Code of the Slate or Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance,
NOTE: Permit limit Ono Year (Except DEMOLITIONS which
ehnll be completed In ninety day.; MOVED -IN BUILDINGS shall be com•
AUTHORIZES
ONLY TI[E
WORK NOTED
signed by the Building Official or his Dep -
uty: and fees are paid, and receipt is ac.
knowledged I.space provided.
pleled in sli months.) .
II 1,AT R' OWN O AGENT) DATE, IONED
(
\
INSPECTION
DEPARTMENT
R
DIRECT SIGNATU
NOTE: Applicant Subject to Plan Check Fee
CITY OF
EDMONDS
775-2525
DATE ^ f /
Till. Permit rUYere work to be I... on private property ONLY.
Anr.n.l, inn nn Ilio Vu bile dnmaln Imran, eldewNke, drleewafe'
r�ln, nlr. nelnr rr,n r 1'rnd.elrn..
FILE
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