750463.pdfd
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DEPARTMENT
USN
PERMIT
NUMBER 750463
BUILDING Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
,
NAME (OR NAME OF BUSINESS)
JOB
ADDRESS
20809 -78th Avenue West
-
Mr. Grossman
LEGAL LOT
LOT AREA SUBDIVISION NO,
.
MAILING ADDRESS
❑ YES ❑ NO
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20809 -78th Avenue West
VARIANCE OR
ADB NO.
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CITY TELEPHONE NUMBER
GOND. USE NO.
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Edmonds, Washington 778-5988
NAME
PROPOSEDYARDS
FRONT
HEIGHT =
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SIDE REAR Z
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ALLOWABLE
PROPOSED -1
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SIGN AREA
SIGN AREA L
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ADDRESS
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OTHER
REQUIREMENTS
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CITY TELEPHONE NUMBER
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PLANNING DEPT. APPROVAL DATE
NAME
1
STREET R/W
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EXISTING STREET R/W
FT. DEFICIENCY THIS PROPERTY
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ADDRESS
COMP, PLAN ST. R/W
FT. FT.
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CITY TELEPHONE NUMBER
REMARKS
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STATE LICENSE NUMBER CITY LICENSE NUMBER
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CHECKED BY W
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Legal Description of Property (Show Below or Attach Four Copies)
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STREET AND/OR UTILITY 13YES in
Lot #4 - Terra Park
WORK REO'D
C3 NO
UNDERGROUND
❑ YES
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WIRING REQ -0
❑ NO
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TYPE CONNECTION
VERIFIED BY
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E]yES PERMIT NUMBER Id
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SEPTIC SYSTEM
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APPVD BY CITY ENG.
❑ NO V3W1
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REMARKS
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METER SIZE SERVICE
512E CLEARANCE CHECKED BY
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REMARKS
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NEW GG/�RESIDEN TIAL LIGAS
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❑
FIRE ZONE TYPE OF CONSTRUCTION CODE
❑ NON-RESIDENTIAL ❑ SIGN
❑ ADD
INSPECTOR AREA
OCCUPANCY OCCUPANT
RETAINING
❑ DEMOLISH ❑ WALL
SPECIAL
REQUIRED
GROUP LOAD
❑ ALTER EXCAVATE FENCE❑
OR FILL I_ x_F<'1
YES Cl No I
PLAN GH EC KED eY
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THIS SITE IS LOCATED IN THE CITY 4.
F-1 PRE•MOVE
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OF EDMONDS. LEOCAL SALES TAX
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REPAIR INSP POOL
REMARKS
SHOO D B
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NUMBER OF STORIES NUMBER OF
DWELLING
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UNITS
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NATURE OF WORK TO BE DONE
COMPLIANCE INSPECTION
PROPOSED USE
VALUATION FEE
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PLAN CHECK
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NO.
a PLOT PLAN INDICATE BUILDING SETBACKS,
R ABUTTING STREETS)
BUILDING
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PLUMBING
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NEAT &GAS LINE
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FENCE
SIGN
RETAINING WALL
SWIMMING POOL
Comp. Insp.
25.00
I hercoy acknowledge that I bave read this application; that the In•
TOTAL AMOUNT DUE
255, 00
formation given Is correct; and that i am the owner, or the duly author-
Ized agent or the owner. f agree to comply with city end state laws rssu-
latingconstruction; and In doing the work authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
x•111 be employed in violation of the Labor Code or the State of Washington
THIS PERMIT
relatlbg to Workmen's Compensation Insurance.
This application is not a permit until
NOTE: Permit Limit One Year (Ezeept DEMOLITIONS which
AUTHORIZES
ONLY THE
signed by the Building Official or his Dep -
shall be completed In ninety day.; MOVED -IN BUILDINGS shall be ram-
WORK NOTED
uty; and fees are paid, and receipt is ac -
plated In .1. months.)
knowledged in space provided.
SIGNATURE )OWNER OR AGENT) GATE SIGNED
Metro Mortgage Co. 9-24-75
INSPECTION
DEPARTMENT
CITY OF
DIR TOR'S SkT
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EDMONDS
[TATE
NOT]3: Applicant .Subject to Plan Chock Fee
775-2525
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This Permit covers work to be done on private property ONLY.
Any Construction on the public domain (curbs, sidewalks, driveways,
ORIGINAL - I'd, YELLOW - InspcUor
marquees, otc.) will require separate permission.
PINK - 0,-,e, GOLD - A, v,
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