750345.pdfi
�.BUILDING DEPARTMENT I Applloant FILL O NE NUMUSE BER 750345
PERMIT APPLICATION Inside Heavy IAnes
DWELLING
UNITS
,oma / � / — ,
ADDRESS
MAI///LJJJIN��JO���JJJJJA'''D AE88
El
CAS
LINE
D
C TT
PB J .BER
TOTAL BLDG. AREA
4 ITEL
' 2 C—
EllADD
❑
AME
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RETAINING
W
METER SIZE
AVATE
lee)
relating to Wor a 's Compensation Insurance.
--
CITY/
TELEPHONE NUMBIER
OR FILL
ONLY TIIE
WORK NOTED
7
�! 2
❑ REPAIR
NAME
14
ADDRESS
tU
FU BER OF STORIES
I NUMBER OF
CITY
TELEPHONE NUMBER
14
CITY OF
I
m 'I
1
I
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
DWELLING
UNITS
,oma / � / — ,
ADDRESS
LiRESIDENTIAL
El
CAS
LINE
NEW
❑
NON-RESIDENTIAL
TOTAL BLDG. AREA
dlcx
EllADD
❑
DEMOLISH
[__j
RETAINING
ALTER
METER SIZE
AVATE
[:]FENCE
relating to Wor a 's Compensation Insurance.
I
❑
OR FILL
ONLY TIIE
WORK NOTED
Ft.)
❑ REPAIR
❑
OV
IH PIdOVF.
El
REMARKS
FU BER OF STORIES
I NUMBER OF
MEMO. TEST
PERMIT NUMBER
DWELLING
UNITS
,oma / � / — ,
ADDRESS
` �' �-o�✓�t
PEItMSSIO
LOT COVERAOFI
ACTUAL
LOT COVESYAOE
PERMISHIBLE HEIGHT
PROPOSED HEIGHT
ACTUAL LOT AREA
TOTAL BLDG. AREA
REQUIRED YARDS
FRON BID? — REAR
PROPOSED YARDS
FRONT SIDE REAR
LEGAL LOT VARIANCE Olt CONDITIONAL USE
YES [] NO PERMIT NUMBER
O i
5
PLANNING DEPT. APPROVAL
DATE:
I
+
C
STREET R/W
EXISTING STREET R/W ............FT.
DEFICIENCY THIS PROPERTY
E -
COMP. PLAN ST. R/W ............FT. ............FT.
1�Rbp77J
L :
R3MARKB
C
W
ATTENTION
CHECKED BY
METER SIZE
SERVICE SIZE CLEARANCE
CHECKED BY
relating to Wor a 's Compensation Insurance.
I
I
I
ONLY TIIE
WORK NOTED
uty; and fees are paid, and receipt is ac-
mpleled ninety days: MOVED -IN BUILDINGS shall be WM-
llnowledged In Space provided.
W
F
< �
I
I
id
REMARKS
TYPE CONNECTION
I VERIFIED BY
MEMO. TEST
PERMIT NUMBER
I
CITY OF
m 'I
1
I
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
I
YES ONO.
SPECIAL INSPECTOR REQUIRED GROUP
0 YES NO
IOCCUPANCY
Tills 1'rr lit r cork to be done on private property ONLY.
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
i
REMARKS
Valuall.n Fee Receipt No.
Plan Check N. .....................
O CL /^ � 1 V '4 _. n 'e BUILDING
4fV ,
PROPOSED UHE '- 1
PLUMBING
U
PLOT PLAN (Indicate Building setbacks, abutting street.) HEAT A GAS LINE r Q
el
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL '
I
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DILE
�. Q
I hereby acknowledge that I have rend this application; that the In.
formal[., 9111, le ..meet; and that I am the owner, or the duty author.
I,. agent of the owner. I agree to comply with oily end .tate law. reg.-
lacing conitruelfoo; and In doing the work authorised thereby, no parson
ATTENTION
APPLICATION APPROVAL
will b1 employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
relating to Wor a 's Compensation Insurance.
AUTHORIZER
signed by the Building Official or his Dep -
NOTE: ermit Wit One Year (Except DEMOLITIONN which
ONLY TIIE
WORK NOTED
uty; and fees are paid, and receipt is ac-
mpleled ninety days: MOVED -IN BUILDINGS shall be WM-
llnowledged In Space provided.
X.? 1 six moot n.)
dl6 T 1tE (O NER Oft AGENT) DATE ZONED
INSPECTION
DEPARTMENT
DI CTOR'd gJONAD RD - _— -^-
I
CITY OF
ED11fOND8
DATE , _
NOTE: Applicant Subject to Plan Check Fee
775-2525
Tills 1'rr lit r cork to be done on private property ONLY.
Any e.netruellon on the public domain (curbs, eNswalka, drWeway.,
marquees, 11c.) w111 require s",wate permission.
FILE