750229.pdf�- --•--------
BUILDING DEPARTMENT AppllrentF►ll zO N9�vl 750229
PERMIT APPLICATION I Inelde Heavy Lines ,ADGB n10
DRESS/f
NAMEWR NAME OF HUI j,BINEBS) l _ - -
-PialtmikISIBLE 7e
v ( G LOT COVERAGE LOT ACTUAL
L 7. OE
MAILINO ADDRE88
PERMISSIBLE HEIGHT PROPOSED HEIGHT
DR LL UOQ 'e ACTUAL LOT AREA TOTAL BLDG. AREA
CIT,yaY•. .,I/)�J, T^EILEP/HONE NUMBS/R
/� 4 MVA &S / 74 —6 Z *J REQUIRED YARDS PROPOSED YARDS
(., NAME FRONT BIDE REAR FRONT SIDE REAR
— LEGAL VARIANCE OR yUj ADDRESS 0 YES LOT❑ NO PERMIT NUMBER
NDITIONAL USE
7 PLANNING DEPT. APPROVAL DATE:
CITY I TELEPHONE NUMBER
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME
COMP. PLAN BT, R/W ............FT. ............FT.
REMARKS
M ADDRESS
10,
eU (CHECKED BY
F CITY TELEPHONE NUM13ER
V I METER SIZE I SERVICE SIZE I CLEARANCE I CHECKED BY
i
O
1^
u
FIRE ZONE I TYPE OF CONSTRUCTION STREET IMPROVED
YES13NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES ❑ NO
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
••"•" •"'•`•' •". •"' •"'•
Pion Check Nn
Valuation
El
GAS
LINE
NEN
El
NON-RESIDENTIAL
y:
Blax
ADD
❑
DEMOLISH
❑
yALL KING
USE
ALTER
EXCAVATE
U
FENCE®
❑
OR FILL
(•�x. .v....ITt.)
❑
REPAIR
A (^�^` � Ol
FRE-MOVEO
SWIM
{
❑
RETAINING WALL
{
IU,IIBER OF STORIES
NUMBER OF
SWIMMING POOL
DWELLING
DEMOLITION
UNITS
FIRE ZONE I TYPE OF CONSTRUCTION STREET IMPROVED
YES13NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES ❑ NO
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
••"•" •"'•`•' •". •"' •"'•
Pion Check Nn
Valuation
Fee Receipt Nu.
I III
I
.....................
y:
BUILDING
PROPOSED
USE
PLUMBING
U
Z PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAB LINE
O
O
PENCE
A (^�^` � Ol
SIGN
{
RETAINING WALL
{
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
��11
I hereby acknowledge that I have read this application; that the In-
G�10 Q
formation given is correct; and that I am the owner,or the duly author-
Ized agent of the owner. I agvee to comply with city and state laws regu.
ATTENTION
APPLICATION APPROVAL
taling conatmetlon; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Slate of Washington
TIDS PERMIT
This application is not a permit until
relating to Workmen's Compensation Iasurmaa.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
Bty; and fees are paid, and receipt is ac -
shall be completed In ninety day.; IIIOVED-IN BUILDINGS shall be cam-
knowledged in space provided.
'
pleted In sixmonths.)
SlONA UIIE (OWN R OR GENT) DATE SIGNED
INSPECTION
D CTOR'B NAT-: •;?_ -
7 /
DEPARTMENT
(,(,C,•L'i. :�l�.'(, fL, i�Z.C.LLL'll
I
CITY OF
NOTE: Applicant Subject to Plan Cbeck Fee
EDMONDS
DATES
�^
775-2525
7'M1ls i'ennit eurrrs work to be done on private property ONLY.
Any tenet Olrllnn sn Il,r public dmmain (rnrbe, slArwnlNs, driveways.
rt i,� ,It, r mar,. •. Verul,• i,,•rnd. sNu,.
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