740189.pdfBUILDING DEPARTMENT I Applicant.
PERMIT APPLICATIONInside Heavy
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LEGAL LOT VARIANCE OR CONDITIONAL USE
0 YES [3 NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
79,
STREET R/W.
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
TYPE OF
13 NO
RESIDENTIAL OAS
El NEW F LINE
El NON-RESIDENTIAL SIGN
RETAINING
ADD ❑ O
DEMOLISH
ALTER ❑ EXCAVATE ❑ FENCE/
OR FILL (......... .x .......... Ft.)
EjrREPAIR PRE -MOVE SWIM
INSP. POOL
❑ YES ANO
PLAN CHECKB
'
MARKS
ll/Alrl :liaci
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THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
��.tJ Pz ;Ci im 7 d
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURRrE- OF WORK TO BE DONE
Valuation Fee Recelpt No
�,4 l 10 (2 O Of R
Plan Check No .....................
[O
BUILDING
4 PROPOSED USE
�JJV J
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
a
�+
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this
ls application; that the in.
AMOUNT DQE
Q
��.•
formation given Is correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state laws regu-
ENTION
APPLICATION APPROVAL
latingF
construction; and In doing the work authorized thereby, no person
will be employed In Violation of the Labor Code of the Stale of Washington
THIS PERMIT
This application Is not a permit until
relating to Workmen's Compensation Insurance.
HORIZES
signed by the Building Official or his Dep -
NOTE: Permit limit One Year (Except DEMOLITIONS whichB
LY THE
NOTED
ande s
Dty and fees are paid, and receipt is ac-
d, ander
ehalt be completed In ninety days; MOVED -IN BUILDINOS shall be corn•
o;
apace
pleted.
d In sig ...the.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
PECTION
D R'S SIGNATU
ARTMENT
TY OF
11
EDMONDS
DAWE
N TE: Applicant Subject to Plan Check Fee
Thin1'ermll fol'en worn to be done on private property ONLY.
PB a-IIOI
Any canelrartlnn on the public domain (curbs, eldewNke, driven'aye,
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RECORD OF INSPECTIONS'
Date Passed
'Foundation —
Plumbing (Partial) —
_
(Rough) _
Froma
Furnace & Fuel Lines—
inesFna
Final
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