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G DEPART ENT Applicant Fill
,APPLICATIONLlBlde Heavy Llnc;eAME OF USI,NEEBB)
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ITREET SETBACK
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710532
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1.
AR -YARD SETBACK
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CANT SITE I
YES ❑ NO
PLOT PLAN APPROVED
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STREET R/W
EXISTING STREET R/W ../� DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W Aco...FT. ... 6... FT.
REMARKS
Driveway slopes not to exceed those
-7 7 /6 METER SIZE I BERV CE SIZE I CLEARANCE I CHE K BY
G) STATE LICENSE NUMBER�f CITY LICENSE NUMBER d7 p�µ.F777t
Legal Description of Property (Show Below or Attach Four Copies) Q 1 ^2 UPC. g
Q F I--PL �,^ TYPECONNECTIONVERIFIE BY r �..+ c i IFS) Lin !SqA
PERC. 1T I PERM ' UM ERri
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W REMARKS m
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0
is FIRE Z I TYPE OFRUCTION I STREET IMPROVED i
r7 NN ❑ YES ❑ NO
SPaMAL INSPECTOR REQUIRED IOCCUPANC OUP
SAS ❑ YES NO
NEW
j� fj 1 ]ll RESIDENTIAL ❑ LINE PLAN CHECKS BY
I X I Y-"
Y—' NON-RESIDENTIAL ❑ SIGN / I
0 THIS SITE IS LC?Ca rED 1w THc
El ADD ❑ RETAINING
LL REMARKS
El DEMOLISH CITY OF EDMONDS. LOCAL SALES
ALTER ❑ EXCAVATE ❑ FENCE TAX SHOULD RE rnnFL) 31 OA
OR FILL (......... z.......... Ft.)
REPAIR PRE-INSP. SOIL
NUMBER OF STORIES NUMBER OF
DWELLING /
UNITS
NATURE OF WORK TO BE DONE Valuation Fee Receipt No.
Plan Check No .... .... ...........
.ZOi BUILDING
PROPOSED USE
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT A GAB LINE G
07
FENCE
SIGN
'r RETAINING WALL
IId
ISWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I
TOTAL AMOUNT DUE .. Q
I hereby acknowledge that I have read this application; that the in- ` LLL
formation given is 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 regu-
lating construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington THIS PERMIT This application is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED utyi and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED -IN BUILDINGS shill be com- knowledged in space provided.
pleted In six months.)
SIGNATURE (OWN OR AGENT) DATE SIGNED INSPECTION DEPARTMENT DIRE OR'8 S1 'rU �
OITY OF
EDMONDS DATE
NOTE: Applica ubject to Plan Check Fee
PH e-II07 �.
This Permit covers wor be done on private property ONLY.
Any construction on the ptiUn domain (curb@, sidewalks, driveways, FILE
muquees, etc.) will require separate permission.
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