750334.pdfU
BUILDING DEPARTMENT Applicant Fill USE NE NUMBER
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME �(u•`-BUSINESS)
C../
MAILING ADDRESS
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NEN HRESIDENTIAL F-1 LIN E
NON-RESIDENTIAL ❑ SION
0 ADD RETAINING
DEMOLISH WALL p
❑ ALTER ❑ OROFILLTE,Q,Q.n.. ;.�...M.7
REPAIR ❑ IN. PRE -MOVE ❑ POOL
LUMBER OF STORIESI NUMBER OF
DWELLING
UNITS
AD
ADDRESS
r t %tet rr n
PERMISBIBI.E % r
LOT COVERAGE
ACTUAL
LOT COVEIAGE
PERMISSIBLE HEIGHT
PROPOSED HEIGHT
ACTUAL LOT AREA
TOTAL BLDG. AREA
REQUIRED YARDS
FRONT BIDE
PROPOSED YARDS
REAR FRONT SIDE REAR
SR
LEGAL LOT VARIANCE OR CONDITIONAL USE
E3 YES I] NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
STREET R/W C
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
z
z
0 YES 0 NO
COKED aY
Plan Cheek No .....................
C
In
F
e
m
r
m
SR
[Or
STREET IMPROVED
YES O NO
LOCAL SALES TAX
Valuallon I Fee
,
Plan Cheek No .....................
In
[Or
BUILDING
W PROPOSED USE
PLUMBING
PLOT PLAN (Indicate Bullding setbacks, ebulling elrcela)
HEAT & 6A9 LINE
��.
FENCE
SIGN
RETAINING WALL
BWIMMIN6 POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
formation given is correct; and that I — the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state lawn reg t-
ATTENTION
APPLICATION APPROVAL
lating construction; and In 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
relating to Workmen's Compensation Insurance,
AUTHORIZES
Signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac -
.hall be completed in ninety day.; MOVED -IN BUILDINGS shall be coin-
knowledged in space provided.
Pitted in elx months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
i
INSPECTION
DEPARTMENT
ACTOR' IGNAT RE%
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CITY OF
pp^"t�{.,;� �1 1
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
— `—
Tide Penult Collins work to be done on private property ONLY.
775-2525
Any construetlnn on the public domaln (curM1s, sidewalks, driveways,
,,,antra.. r, .1"A,r 111 r,nnlrr ..para;, I.r,al�sian.
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