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BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION IDd,de Heavy Lines
a FNAME
MA i2sIHU DDRESS
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or
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ISTED ON KROLL MAP NO.: PERM
E BER 'j I O I 22
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B ADDREdB.VW
,W AV
SIDE YARD SETBACKI
STREET SETBACK (
REAR YARD SETBACK
USE ZONE
I LOT AREA
VACANT BITE
YES 0 NO
HEIGHT
I BUILDING AREA
i VARIANCE NUMBER
NEW
IJ(' RESIDENTIAL
/U�
❑
GAS
LINE
NON-RESIDENTIAL
❑
SIGN
ADD
❑
DEMOLISH
tT�A,INING
❑
EXCAVATE
ALTER
Fl
ORFILL
❑
(...NC x
Ft.)
El REPAIR
❑
INSP. MOVE
..........
wim
POOL
iUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
iATURH7- ns wW
TO BE DONt
YLUT YLAN AYYROVI+LJ
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
0 YES ❑ NO
'- Plan Check No .....................
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BUILDING
PLUMBING
.backs, abutting streets) HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A51OUNT DUE
I hereby acknowledge that I have read thin application; that the in.
formation given Is correct; and that I am the owner, or the duly author.
tile
lzed agent or the owner. I agree to comply with city and state laws regu.
ATTENTION
latlag construction; and In doing the wont autho:lzed thereby, no person
will be employed In violation of the Labor Code of the Stale of Waehington
THUS PERMIT
relating to Workmen's Compensation Insurance.
AUTIIOIUZEH
NOTE: Permit Limit One Year (Except DEMOLITIONS which,
ONLY THE
li'ORHC NOTED
shall be completed In ninety days; a[OVEU-IN BUILDINGS shall be com-
pleted In six months.)
it NA 'U1tE (OWNER Oft- AGL•'NT DATE
INSPECTION
DEPARTMENT
/ i C� 7/
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
rn a -Igor
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
CLEARANCE
BY
YES 0 NO
Fee
Z3 •"
E
D
r
No.
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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-
lmowledged in space provided.
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RECORD OF INSPECTIONS
J S _ Date Passed . �
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_. Foundation
Plumbing (Partial)
K'
Frame
1 Furna
ce & Fuel Lines '
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...._RECORD OF --INSPECTIONS
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Drainage
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Sewer
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Parking �;L
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Landscaping, ;:,;,, e,
Fire Dept.VA
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