750263.pdfH
7
C
S
I / 7 //
iV
16 1
-.
NEW
,LEGAL LOT VAR ANCE Olt CONDITIONAL USE
LINE
0 YES (3 NO PERMIT NUMBER'
-
❑
i
BUILDING DEPARTMENT
DEPT. APPROVAL DATE:
i�E PERMI
750263
STREET R/{V
Applicant Fill
t
EXISTING STREET R/W ............FT, DEFICIENCY THIS PROPERTY
$aO
PERMIT APPLICATION
Inside Heavy Lines
(
.MoD
WI
°
Z
REMARKS
EXCAVATE
ADDnEsa
w
j
�. O O
NAME (OR OF NAME BUSINESS)
ORFILL
.IE
R'.o.�Jt...4-Ft.)
M
�%
A J M V Y•e-
PLIta118tl3BLE ACTUAL J
LOT COVERAGEe LOT COVERAGE
MAILING ADDRESS
CITY LICENSE NUMBER
ML•T—.ILE
5
Soo
/
P
PEfthl ldBIBLE fiF.IG11T PROPOSED HEIGHT
It
I
,
1 z�' .- o t,,w � ,
,,
I
H
7
C
S
I / 7 //
REQUIRED YARDSPROPOSED YARD.
FRONT .IDE RF,AR FRONT BIDE It.
16 1
z
NEW
,LEGAL LOT VAR ANCE Olt CONDITIONAL USE
LINE
0 YES (3 NO PERMIT NUMBER'
PLANNING
❑
PLUMAINI
TELEPHONE NUMBER
DEPT. APPROVAL DATE:
STREET R/{V
EXISTING STREET R/W ............FT, DEFICIENCY THIS PROPERTY
$aO
�) t�
D ly t -It
COMP. PLAN ST. R/W ............FT. ............FT.
WI
°
Z
REMARKS
EXCAVATE
NCE
3j
w
j
�. O O
TELEPHONE NUMBER
ORFILL
CHECKED BY
.IE
R'.o.�Jt...4-Ft.)
REPAIREljNePMOVE
IE NUMBER
CITY LICENSE NUMBER
ML•T—.ILE
BLRVICE SIZE
CLEARANCE
CHECKED BY
O
I
LIMBER OF STORIES
NUAIDEft OF
I
I ! I
)n of Property (Show Below or Attach Four Coplea)
REMARKS
0 YES 0 NO
p YES ❑ NO
LOCAL SALES TAX
Plan Check N...... ................
RESIDENTIAL
z
NEW
LINE
BUILDING
NON-RESIDENTIAL
❑
PLUMAINI
ADD
SIGN
A PLOT PLAN (Indlertto DulldlnR 9etbaeke, ¢boiling elreale)
HEAT & GAS LINE
RETAINING
ElDEMOLISH�wALL
ALTER
FENCE
EXCAVATE
NCE
3j
3 Q
�. O O
❑
ORFILL
SIGN
.IE
R'.o.�Jt...4-Ft.)
REPAIREljNePMOVE
RETAINING WALL
SWI M
N
O
LIMBER OF STORIES
NUAIDEft OF
DESIOLITION
DWELLING
PRE -MOVE INSPECTION
UNITS
0 YES 0 NO
p YES ❑ NO
LOCAL SALES TAX
Plan Check N...... ................
z
PROPOSED UBE
BUILDING
C
Q
PLUMAINI
A PLOT PLAN (Indlertto DulldlnR 9etbaeke, ¢boiling elreale)
HEAT & GAS LINE
9
O
FENCE
3 Q
�. O O
SIGN
RETAINING WALL
N
SWIMMING POOL
DESIOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
qtr
TOTAL AMOUNT DUE
17�r o O
I hereby acknowledge that I have read thin apPllealloa; that the In,
r¢rmatlon
given 1. correct: and that I Ann the owner, or the duly author-
ized ,Rent the owner. I agree to comply with city and ,tate ,awe ergo-
tr
toting coaatructloa; and In doing the work authorized thereby, oo Dereon
ATTENTION
APPLICATION APPROVAL
will be employed In Violation of the Labor Code of the State of Washington
Tlud PERMIT
relating to Workmen'. Compenaetlon Ineurance.
This application is not a permit until
AUTHORIZER
ONLY TIME
signed by the Building Official or his Dep.
NOTE: Permit Limit One Year (Except nem LITIONS whleh
uty; and fees
.hall ho completed In y days; M)VED-I 6UILD7 9 ahnll be
{YORE NOTED
are paid, and receipt is ac -
cam-
Dieted In elx ...the.)
knowledged in space provided.
SIGNATURE —MER -5.9A— DATE BIGNED
INSPECTION
'-
_
DEPARTMENT
III OR's a ATU -- ;,fM.....w..
G ..S
CITY OFMEM
��/!
EDAIONDS
DATE
NOTE: Applicdut Subject to Plan Check Fee
Titler—It --work to be done on private property ONLY.
775-2525
S'^
a
Any eonatrnrtl¢n On the pablte domaln (curb-, nldewalka, dfl—eye,
ni.�r,)i�,•,... r".) Illi rrnnlr, �eDurutc prrinl--{nn.
FII,F,