740121.pdfr
BUILDING DEPARTMENT
Applicant FILL
ZONE rPioMs 740121
PERMIT APPLICATION
I Inside Heavy Lines
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NAME (OR NAME OF BUSINESS)
ADDRESS
724 Elm Street
Belt Homes
PERMISSIBLE q �g ACTUAL
LOT COVERAGE ` LOT COVERAGE
35
M
MAILING ADDRESS
d
9808 -215th Ave. SW
PERMISSIBLE HEICIIT P OSED HEIO V
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CITY
TELEPHONE NUMBER
ACTUoAL yOTy,,AREA TOTAL DO EA
Edmonds, Wn.
776-2829
/ 78"d
J/REQUIRED z
NAME
YARDS PRO. YARDS
FRONT SIDE REAR FRONT BIDE REAR
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ADDRESS
LEG LOT VA RPANCE OR CONDITIONAL USE
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CITY
NUMBER
PL 7 D PP L ATE•
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(TELEPHONE
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NAME
EXIB O STREET R/ .. DEFICIENCY THIS PROPERTY
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REMARKS Driveway slopes not to exceed those
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i-ndicated on Standard Dwg. No
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CHECKED SY
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TELEPHONE NUMDEft
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METER SIZE B&RVICE SIZE CLEARANCE
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STATE LICENSE NUMBER
CITY LICENBE NUMBER
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Legal Description of Property (ell.,REMARKS
Below
or Attach Four Copies)
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Lot #4 - Elm View Addition,
TYPE CONNECTION
VERIF'IE HY
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PERC. TEST
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REMARKS
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FI�R-EZO—NETYPL• OF CONSTRUCTION STREET ISSPRO VED
YES E3 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
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® RESIDENTIAL
❑ GAS
LINE
❑ YES @'NO �'i/
NEW
NON-RESIDENTIAL
PLAN CHECK D Y THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES
ADD
SIGN
TAX
❑ DEMOLISH NAL VINO
A Se
ALTER EXCAVATE FENCE
OR FILL
(..........i_........Ft.)
PRE -MOVE
REPAIR SWIM
INSPI I. POOL
•S`%�a2�7u T-LyLr%l
NUMBER OF STORIES NUMBER OF
DWELLING
2 UNITS I
NATURE OF WORK TO BE DONE
New Res id nce
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Valuation
Fee Receipt No.
Plan Check No ...................
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BUILDING
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PROPOSED UBE
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IG!/L' LL 1 /�G
PLUMBING
a
PLOT PLAQN (Indicate Building eetbncka, abutting Streets)
HEAT & GAB LINE
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14 17-_,0L&
FENCE
1
SIGN
RETAINING WALL
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N
1
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
'
TOTALAMOUNT DUE
/36 v-0—. 976
I hereby acknowledge that I bnve read this application; that Lee In.
formation given Is correct; and the' I am the owner, or the duly author-
Szedagent r the owner. I agree to comply With Illy and elate Inmos ergo•
lati
)ming conetruetlon; and W work
doing the work author):ad thereby, no Person
ATTENTION
APPLICATION APPROVAL
will be employed In vlolntlon of the Labor Code of the State of Washington
TINS PER511T
relating to workmen's compensation Ineuranu.
AUTHORIZES
This application is not a permit Until
NOTE: Permit Limit One Year (Eieept
ONLY THE
signed by the Building Official or his Dep-
�___"_--•---- '
DEMOLITIONS which
shall be completed In ninety days; MOVED•IN BUILDINGS shall be cam•
WORK NOTED
uty; and fees are paid, and receipt Is ac -
pleted In els months.)
knOWled ged In a ace prov dad.
SIGNATURE (OYNER OR AGENT) DATE SIGNED
INSPECTION
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DEPARTMENT
IRE OR, LONA E
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gllliesig in
CITY OF
`
NOTE: Applicant Subject to Plan Check Fee
EDMONDS
DATE
!
Th! s Permit coven work to be done on Private Property ONLY.
PR a-1107
2,0 74
Any construction en the public domain (curbs, Sidewalks, driveway.,
'o.". ee, rtcJ u911 requlrc Separate permission.
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