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LDING DEPARTMENT Applicant 11111 ONE NUM's /7)40»7 1
RMIT APPLICATION
Inside Heavy Lines
JOB a O
ADDRESS / J j
(OR/ NAME OF BUSINESS) / 1
� PERMIBBIBLE % ACTUAL
LDT COYERAOE LOT COVEHAOE
NO ADD� / /�/���^���PERMIBBIBLE HEIDIIT PROPOSED HEIGHT
RI '^�LEPHONE NUMPx.a AMU— I.OT AREA TOTAL BLDG. AREA
76 _.�'Z 22
yADDRESS
F
U
CITY
NA�M/TE�J['S�
in
AI REBB� / I
2-
CITY
CITY
kn Lin
G STATE LICENSE NUol—
ya :1_e%/_ 9'77
FRONT BIDE REAR FRONT SIDE REAR
LEGAL LOT VARIANCE OR CONDITIONAL UBE
0 YES 0 NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
STREET RIW
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ IT- ............FT.
REMARKS
Plan Cheek No .....................
E
10 YES 0 NO
BUILDING
[:
L
SPECIAL INSPECTOR REQUIRED GROUP
❑ RESIDENTIAL
E]Llxe
OAS
IOCCUPANCY
[3 YES ❑ NO
F-1
NEW
PLOT PLAN (Indicate Building setbacks, abutting street.)
HEAT @ GAB LINE
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
O
❑
NON-RESIDENTIAL
❑
SIGN
OF EDMONDS. LOCAL SALES TAX
❑
ADD
❑
RETAINING WALL
❑
RETAINING
WALT
SHOULD IIE CODED 31.04.
REMARKS
❑
ALTER
DEMOLISH
EXCAVATE
SWIMMING POOL
FENCE
Section 12.14.040 (fence requirements)
DEMOLITION
❑
OR FILL
(..........x .......... Ft.)
❑
REPAIR
❑
PRE -MOVE
El
SWIM
INSP.
TOTAL AMOUNT DUE
attached.
;UMBER OF STORIES
NUMBER OF
I hereby acknowledge that I have read this application; that the In-
s
G( /
formation given to correct; and that I and the owner, or the duly nuthcr-
DWELLING
Iced agent of the owner. I agree to comply with city and state law. regu-
ATTENTION
APPLICATION APPROVAL -�
lating construction; and In doing the work authorised thereby, no person
UNITS
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit lentil
PATURE OF WORK TO BE DONE
AUTHORIZES
signed by the Building Official Or his Dep -
I Valuation I Fee Receipt No.
Plan Cheek No .....................
E
BUILDING
[:
L
PROPOSED USE
'4t
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting street.)
HEAT @ GAB LINE
O
FENCE
®
Q J
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
�J ^J��
I hereby acknowledge that I have read this application; that the In-
s
G( /
formation given to correct; and that I and the owner, or the duly nuthcr-
Iced agent of the owner. I agree to comply with city and state law. regu-
ATTENTION
APPLICATION APPROVAL -�
lating construction; and In doing the work authorised 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 lentil
relating to Workmen's Compensation Insuraace.
AUTHORIZES
signed by the Building Official Or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
uty; and fees are paid, and receipt is ac -
.hall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
WORE NOTED
knowledged in space provided.
pleted in mix months,)
8 ATURE (OW ER 9A AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
DIREC'I'OR'S igNATU _
((i
7'1-
e
CITY OF
ED3IIONDB
DATE _
NOTE: Applicant Subject to Plan Check Fee
PR e•I107
_!5
This Permit coven work to be eon. an private property ONLY.
Any eaa.truetion on the public domsln (curb., 0"walks, driveways,
margneem etc,) wet require .ennrote leeloa.�