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24017 79TH PL W
PATE RECEIVED
PE RMIT EXPIRES
CITY OF EDMONDS
USE
ZONE PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS fc.tkoE.- U)6'4v--
OWNER NAME/NAME OF BUSINES
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PLAT NAME/SUBDIVISION NO.
LOT NO.
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LID NO.
LID FEE $
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MAILING A PPRES�_
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Apprmed 0
0
EXISTING - PROPOSED
RW Permit Required 0
Street Use Permit Req'd 0
Inspection Required 0
CITY Zip
ELEPHONE
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REQUIRED DEDICATION- FT
Sidewalk Required 0
Underground
Wiring required
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES 0 NO 0
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ADDRESS
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY
TELEPHONE
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INSPECTION
REO'D
PBOND
OSTED
STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
0 YES 0 NO
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
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PROPERTY TAX ACCOU�T PARCEL NO.
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LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT L/R SIDE REAR
AUDITION COMMERCIAL o COMPLIANCE OR
CHANGE OF USE
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PARKING
IDED
LOT AREA
PLANNING REVIEWED BY DATE
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REPAIR GRADING FENCE
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DEMOLISH TANK It 17-4 OTHER
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GARAGE RETAINING WALL RENEWAL
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0 CARPORT C3 ROCKERY
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(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY
TYPE OF CONSTRUCTION
COD�: OCCUPANT
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NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
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SPECIAL INSPECTOR
OCCUPANT
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STORIES
UNITS
NUMBER
JAREA
REQUIRED F] YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER LIBC 108/FINAL INSPECTION REO'D
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VALUATION
FEE
PLAN CHECK FEE
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HEAT SOURCE
GLAZING %
1
LOT SLOPE %
BUILDING
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PLUMBING
HECK NO:
VESTED DATE
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
G RADING/FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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SEPARATE PERMISSION.
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PERMIT APPLICATION: 180 DAYS
NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of'Edmonds does not warrant the
accuracy of anything set for ' th on these
map(s). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
the -map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
emp-l-o-yee-s o-r officers -sh-all be 1--ia-bl-e for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
The City of Edmonds
9tEE,3T
APPLICATION
for
SEDE SEWER PERMIT
OUTSIDE Ej-' INSIDE REPAIRS 0
FILE
CARD No . ......................................
EASEMENT No . ......................................
"7-"l 41el
OWNER ...... —6Z ....... ........ . ..... ---- ----------------------
HOUSE No - ------ Z.4�0-17 ------------- 7,,',?*,., ...... ....
CONTRACTOR NaZ.714...-BAI.0 ------ MI
PER T No.
STREET 2-
AVENUE LOT No . .......... ............ ................................... ...... BLOCK No . .......................................
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