740097.pdf1
TOTAL AMOUNT DUE
is
❑
LINE
PER
R 7A00g7
BUILDING DEPARTMENT ZONE C NUMBET
�1
NON-RESIDENTIAL
0
Applicant Fill
'skiing to Workmen's Compensation Insurance.
ADD
ElDEMOLIeH
PERMIT APPLICATION Inside Heavy Lines jog
WALL
I ]�I
ALTER
ADDRESS -Y� _ �i���9 /J�
j �
FENCz..........Ft.I
SIGN
NAME (OR NAME OF e� •
❑ OR FILL
INSP.
O
SWI
POOL
ZEBU)
/1P PET COV SLE 70 ' ACTUAL
LOT COVERAOF. LOT COVE
I
I�
EDMONDS
m
MAILING ADDRE O
PERMISSIBLE HEIGHT PROPOSED HEIGHT
I )
qI
O
CITY TELEPHONE NUMBER ACTUAL LOT AREA TOTAL BLDG. AREA
I 3
PRE -MOVE INSPECTION
REQUIRED YARDS PROPOSED YARDS
EXCAVATION OR FILL
T
NAME FRONSIDE REAR FRONT ,IDE REAR
eUj
ADDRESS LEGAL LOT VARIANCE OR CONDITIONAL USE
[+
C3 YES JJ NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
m
CITY TELEPBONE NUMBER
STREET R/1V C
i
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME
• �- COMP. PLAN ST. R/W ............FT. ............FT.
'�-Irr-I'I
tN
,'
✓Jy Ile { /�✓� {u'iJf� fir.✓- - REMARKS x
mOF
ADDREBB7B
,+ r
�� •� �.G BY W
{U
E
/ .j J .S `' CHECKED
C1T ) TELEPHONE NUMBER
rf/I i ie «�� E� y�3Gry a A. BB -4 SERVICE SIZE CLEARANCE CHECKED BY
STATE LICENSE NUMBER CITY LICENSE NUMBER
REMARHB
Legal Description of Property (Show Below or Attach Your Copies) r
I
TYPE CONNECTION VERIFSED BY
I
Z
O
FERC. TEST
PERMIT NUMBER d,
U
r
REMARKS
m
EJNEW
TOTAL AMOUNT DUE
t—+ RESIDENTIAL
❑
LINE
PLUMBING
lating conetructlon; and In doing the work authorized thereby, no Denon
NON-RESIDENTIAL
0
SIGNRETAINING
'skiing to Workmen's Compensation Insurance.
ADD
ElDEMOLIeH
ONLY THE
WALL
I ]�I
ALTER
EXCAVATE
❑
FENCz..........Ft.I
SIGN
REPAIR
❑ OR FILL
INSP.
O
SWI
POOL
UMBER
4UMBER OF STORIES NUMBER OF
EDMONDS
NOTE: AQQllcant Subject to Plan Check Fee
SWIMMING POOL
DWELLING
DEMOLITION
nm reun,, ric,) was reamre .'Perot, permIeelon.1111
PRE -MOVE INSPECTION
Ia e,c / *00S,1�
I10 YE8,NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY CROUP ^
YES ANO I �' K
PLAN CHECIIF;D DY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD B CODED
REMARKS
,&Xy #
0/9C if 70 ° PW 7ilODS'3
Valuation Fee I Receipt No.
ti
�y
TOTAL AMOUNT DUE
Plan Check No. ....................
BUILDING
i PROPOSED USE
Isc6 agent Of the owber. I agree to comply with city and etnle laws regu-
PLUMBING
lating conetructlon; and In doing the work authorized thereby, no Denon
ATTENTION
will he employed In vlolatlo¢ or the Labor Code of the State of Washington
OPLOT PLAN (Indicate Building setbacks, abutting streets)
'skiing to Workmen's Compensation Insurance.
HEAT A GAB LINE
O
ONLY THE
,hall be completed In ninety, days; MOVED -IN BUILDINGS ,hail be com-
O
pleted In ,ix menthe.)
FENCE
316NATURE (OWNER O GENT) DATE SIGNED
INSPECTION
SIGN
DEPARTMENT
tRETAINING
WALL
N
EDMONDS
NOTE: AQQllcant Subject to Plan Check Fee
SWIMMING POOL
This Permit coven work to be done an private property ONLY.
DEMOLITION
nm reun,, ric,) was reamre .'Perot, permIeelon.1111
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application: that the in-
TOTAL AMOUNT DUE
formation given le correct; and that I sen the owner, or the duty nuthor-
Isc6 agent Of the owber. I agree to comply with city and etnle laws regu-
lating conetructlon; and In doing the work authorized thereby, no Denon
ATTENTION
will he employed In vlolatlo¢ or the Labor Code of the State of Washington
TINS PERMIT
'skiing to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
,hall be completed In ninety, days; MOVED -IN BUILDINGS ,hail be com-
WORK NOTED
pleted In ,ix menthe.)
316NATURE (OWNER O GENT) DATE SIGNED
INSPECTION
DEPARTMENT
3 ^
CITY OF
EDMONDS
NOTE: AQQllcant Subject to Plan Check Fee
PR d-7107
This Permit coven work to be done an private property ONLY.
Any construction on the publlo domain (e=bs, eldewnike, drlvewgs,
nm reun,, ric,) was reamre .'Perot, permIeelon.1111
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.
FILE