680476.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME
WASE
C.
,P NO.:
PERMIT
NUMBER
Slot igtl) gETBACK STREET SETBACK REAR YARD SETBACK
Co ou S
MAILJNG ADDRESN_
'TTAM Zopm LOT AREA VACANT SITE
TELEPHONE NUMBER NO
/-V^-'*Au wood T BUILDING AREA VAIUANCE NUMBER
75�, -6 57 eCh
NAME PLOT P
t Ves; &1.-) /9:5;5 a c-;
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R 7o F- 41 5A—"r P4. STRSEr
EXI 4";REErr R/W XT. DEFICIENCY THIS PROPERTY
CITY TE—LEPHONE NUMBER Not S
COMP. PLAN ST. R/W M.
El- -3 - 74 Z 2. _ff E—MARKS 0
NAME
YI7 C: 0 Driveway slopes not to exceed those
ADDRESS indicated on Standard Drawing #103.
0. e3oN 1 1] NUMBER CHECNED BY
LA 16 5 G/S _MTER SIZE SERVICE SIZE C4ECPW BY
r
STAW&J b1cENSE NUMBER QrXY LACENSE NUMBER 71 ICLEARANCE
MARKS
Legal Description of Property tanow Selow or Attach Four Copies)
A Lki c. -7.
PERC. TIMT
PERV��MBER
T. 7 e,
Aj.slx s:A
REMARKS
FIRE ZON�E 0 STREET IMPROVED
.. I TYPE OF C TRUcTIoN
1-E I-- T 10 YES [3 NO
SPECIAL INSPECTOR REQUIRED
GROUP
11 YES 11�160
ioCCUPANCY
RESIDENTIAL GAS
NEW kn4 LINE
NON-RESIDENTLkL SIGN
RETAINING
DEMOLISH WALL
F� ALTER EXCAVATE FENCE
E] OR FILM ( x Ft.)
REPAIR PRE -MOVE swim
INSP. El POOL
PLAN CHEC Y
ES
NUMBER OF
DWELLING
UNITS J N
Plan Check
PROPOSED USE
---A
:5 "Ai cr /
BUILDING
e
—PLAN
PLOT (Indicate Building setbacHB, abutt!ng streets)
0 7&
PLUMBING
HEAT & GAS LINE
ro
PENCE
to
SIGN
It(
RETAINING WALL
SWIMMING POOL
a-
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
z
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given In correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws rogu-
lating construction; and In doing the work authorized thereby, no person
ATTENTION
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTUORIZES
NOTE: Permit Umit One Year (Except DEMOLITIONS which
ONLY THE
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
WORK NOTED
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: AWficant Subject to Plan Check Fee
PH 6-1107
This Permit coven work to be done ou private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
— use@, etc.) will require separate permission.
Valuation
MN
L I
APPLICATION APPROVAL
This application is not a permit until
Signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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