720063.pdff � �--... � - --
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BUILDING DEPARTMENT I AppLcaatFlll
PERMIT APPLICATION Inside xeaYy I.ineB
0
PERMIT
NUMBER � n D
� pC
'�AC REAR YAA
vwowNT BI
❑ YffiS
CITY I ffi ffiP ONE NUMBIlft EXf8TIN6 BTRE1Cr R/W ......»....FT. DEFICIENOY THIS PROPERTY { ,
COMP. PLAN ST. R/R' ..._._....D'T. ..._.......FT. � � .�
RffiMARKB �1 � -
NAMffi �
o c,J � e.r .t
ADDRESS � � I�.
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CHECKED BY {
CITY I TELffiPHONffi NVMDICR
i
METER 812E 18ffiRVICffi 8I2E I CLEARANCE I OHECKED SY {
STATE LICENBffi NUMBER I CITY ISCENBffi NUMBER ,
i
R MARKS � '�,....
Legal DezcrlDtlon of Property (Show Below or Attach Four Coplea) (; .�;
TYPffi CONNECTION I VERIFIED BY �
i
PERC. TEST PERMIT NUMBER ppp��� + - � , `. "
t �.
REMARKS � ��� �
� ��.
FIRE 20Nffi TYPE OF CONBTRVCTION BTREffiT IMPROVED j� l
❑ YE8 ❑ NO � "�
s
BPEOIAL INSPECTOR REQUIRED I OCCUPANlIY.6ROUP �
® RESIDENTIAL ❑ 6A8 ❑YES ❑ NO
NEW LffiE PLAN CHECKED BY - � .��, . ��
❑ '
❑ NON-RESIDENTIAL ❑ BION THIS SITE IS LO ' �� ��.
❑ ADD RETAINING REMARKS - �� � �� ��
ITY'OF EDMONDS. LOCAL SALE I
❑ DEMOLISH ❑ WALL t`
❑ ALTER EXCAVATE ��7�yt� FENCE � TAX SHOULD BE GOD -D 41 Q�; {.' ,
❑ OR FILL Ii.. T d3.Z.s �:..Fe.) � _ , �.' ..
❑ REPAIR PRE -MOVE HW1M � �. , � , T .
❑ INBP. ❑ POOL { �
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS � `�' -
}I : ;
NATURE OF WORK TO BE DONE Valu¢tlon Fee Receipt No. 1 �.' � :�'
� �� c� � _
Pisa Check No....»......_....... �, i. � -
�_. `
. SUIDDIN6
PROPOSED U8ffi �'-�
PLVMHIN6 { �-
PLOT PLAN (Intllcate Building setbacks, nbuttlag streets) HEAT do GAB LINE �,, ��, , � ��
f':
FENCE ��
BION ,oD jf�
1'.
;; i .
RETAIIZIN6 WALL ;? ,
I
SWIMMING POOL �'�
�,,
DEMOLITION �.
PRE -MOVE INSPECTION ���
(
EXCAVATION OR FILL � �,. '1
I
TOTAL AMODNT DUE {t
I hereby acknowledge that I have read thlg apDllcatlon; that the 1n- p� - 0 d � � � 6
forinatfoa gtvan fa correct; and that I am the owner, or the dolt author+- I
Ized agent of We owner. I agree to oomply wuh ally and elate Iowa raga- ATTENTION APPLICATION APPROVAL 1
latlag coaatructlon; nod Ia doug the work autlrorized tbenby, ao Denoa I
will be emDloyM In violation of the Lntwr Code of the seats o! Weahmgtoa TIIIB PERMIT This application is not a permit until � ��-
relating to Workmea4 ComDeasatton Iazutaace. AUTHORIZI68
signed by the Building Otfloial or h!s Dep- ' I
NOTE: Permit Limit One Year (E:nape DEMOLIT10N8 whlan wo sYNOTaD uty; and tees are paid, and receipt iB nc- 1 r ,-
shalt De completed la Hussy any.; MovED-IN Ho>z.Dfxae .hall 1» oom- hnowledged fn space provided. ; ''
plated Ia e1z menthe.)
� � r
IIONATURE (OWNER AGENT) D� HIONffiD INSPECTION D CTOR' BIONAT � i
J�` DEPARTMENT i
OITY OP' '
DATE ,I �:'�.,........�✓-- , _
NOTE: AQpllcant Subject to Plau Chrck Fee EDMOND3 � � f �� ; .
PR alloy
This Permit coven work to be done oa private Droperty ONLY. � � ,
Any eomtructla¢ oa the pob8a domain (Carbg, sidewalks, driveways,
maryueeb etc.) wW reQWre separate peradulaa. FthE
�..� �. ..
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