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BUILDING DEPARTMENT �pvuttms tau
PERMIT APPLICATION I Inside Heavy Ltnee
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ACTUAL LOT AREA
TOTAL BLDG. AREA z
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REQUIRED YARDS
PROPOSED YARDS R
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FRONT NIDE
REAR FRONT NIDE REAR
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ADDRESS
LEGAL LOT N OR CONDITIONAL USE
0 YES0 NO PERMIT NUMBER
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PLANNING DEPT. APPROVAL DATE:
CITY
NH NUMBER
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STREET R/VV
EXISTING STREET R/W ............FT.
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DEFICIENCY THIS PROPERTY $
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NAME
COMP. PLAN ST. R/W ............FI'.
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REMARKS
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AD REBS
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METER SIZE SERVICE SIZE
CLEARANCE
CHECKED BY
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Legal Description of Property (Show Below or Attach Four Copies)
TYPE CONNECTION
VERIFIED BY
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PERC. TEST
PERMIT NUMBER a.
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3
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REMARKS
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FIRE ZO TYPE OF COASTRUCTLON
STREET IMPROVED
•
YES [3 NO
EPSP CIA9 REQUIRED
OCCUPANCY GROUP
OAS
El NEW RESIDENTIAL LINE
❑ YES �NO
THIS
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SITE IS LOCATED IN THE CITY
PLAN CHECKED BY
NDN -RESIDENTIAL
OF EDMONDS. LOCAL SALES TAX
a1aN
❑ ADDRETAINING
DEMOLISH ❑ WALL NINO
SHOULD BE C'.ODED 31 04.
REMARKS
G(�C'C ��
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ALTER ❑ EXCAVATE
OR PILL (P.EN s..........Fl.)
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EJREPAIR ❑ PRE -MOVE SWIM
INSPI POOL
NUMBER OF STORIES
NUMBER OF
%
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Valuation
Fee Receipt No,
Pian Check No .....................
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BUILDING
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PROPOSED USE
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PLUMBING
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PLOT PLAN (Indicate Hull Ing .etbacks, abutting streets)
HEAT & GAS LINE
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FENCE
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SIGN
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tRETAINING
WALL
_
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
2' U 18!
O 778r
TOTAL AMOUNT DUE
I heresy aekoowledge that I have read thisapplication; that the
u
formation given Is correct; and that I am the owner, or the duly author•
Ized agent of the owner. I agree to comply with city and .tate laws .9u-
ATTENTION
APPLICATION APPROVAL
latlnx conslmetlon; and in doing the work authorlud thereby, no person
will be employed In violation of the Labor Code of the Stale of Washington
THIS PERMIT
This application Is not a pertnit until
relating to Workman's Compensation Ioauemoe.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
utyi and fees are paid, and receipt is ac -
shall be completed In ninety day.: MOVED -IN BUILDINOS shall be com-
knowledged in Space provided.
pleted In six month..)
GNA RE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
DIRER'e SIGNATURE
DEPARTMENT
E'S
I
CITY OF
NOTE: Applicant Subject to 16.Check Fee
EDMUNDS
DATE ^'7
PR a•1107
wk to be done an private property ONLY.
This Permit covenor
Any constructionbe the public domain (corp., sidewalks, driveways,
FILE
ch -lures, etc.) will require separate permi.sisn.
CHECKED
TOTAL AMOUNT DUE
I hereby acknowledge that 1 have read thin application; that theI
formation given le correct; and that I am the owner, or the duly autlzed
agent of the owner. I agree to comply with city sad state laws m
ATTENTION
USE PERMIT 74baD6
will be employed In violation of the Labor Code of the Stale of Washin
THIS PERMIT
BUILDING DEPARTMENT I Applicant Fin
ZONE NUMBER
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PERMIT APPLICATION Inside Heavy Lines
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ADDRESS "-. L/,2 .
SIGNATURE (OWNER OR AGENT) DATE S10NEDINSPECTION
PERC. TESTN
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NAME lOR NAME OF BUSINESS)
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PERMISSIBLE ACTUAL J
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REMARKS
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LOT COVERAGE LOT COVEI2A0E
STREET IMPROVED
0 YES 0 NO
Thls Permit coven work to be done on private property ONLY.
Aoy eoastrnctiou on the public domain (carts, sidewalks, driveways,
MAILINO ADDRESS
PERIARIBIBLE HEIGHT PROPOSED HEIGHT
SPECIAL INSPECTOR REQUIRED
GROUP
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ACTUAL LOT AREA TOTAL BLDG. A1 --
IOCCUPANCY
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j'�j ❑ GAS
RESIDENTIAL LINE
NEW ❑ NON-RESIDENTIAL SIGN
ADD ❑ ❑ RETAINING
DEMOLISH WALL
❑ALTER El❑ EXCAVATE PENCE
OR FILL (.......... z .......... Fl.)
PLAN CHECKED HY THIS SITE IS LOCATED IN THE CITY
OF ED BE CODED LOCAL TAX
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C1TY�
ER,
REPAIR
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(,/i J / i. /' / / -{.- /./ L �i
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HEQUIRED YARDS PROPOSED YARDS
NUMBER OF STORIES NUMHER OF
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,�.- _
NAME
FRONT e1DF. REAR FRONT SIllE REAR
DWELLING
LEGALLOT VARIANCE OR CONDITIONAL USE
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ADDRESS
0"..� NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
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pOy
CITY TELEP ONE NUMBER
R/W
No.
STREET
EXIHTINO STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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NAME _ j ,?
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COMP. PLAN ST. R/W ............FT. ............FT.
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REMARKS
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PROPOSED USE
ill
ADDRESS ,' �-
W
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/ I l •.. 1( -•I TELEPHONE NUMBER
CHECKED By
HEAT A GAS LINE
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C TY
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A-
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BY
p , ;( , .' . -, r , . - L r r METER B_1ZE BF.RVICE BIZE CLEARANCE `I
V BTA E LICENSE NUMHER I CIT L CENSE NUMBER / I I Cd
RE KTJ
Legal Description of Property (Show Below or Attach Four Copies) I
--7,061
77971
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 apace provided.
DIRECTOR'S 13IONATURE
DATE r j
r - J�,----- -
INSPECTOR
f
TOTAL AMOUNT DUE
I hereby acknowledge that 1 have read thin application; that theI
formation given le correct; and that I am the owner, or the duly autlzed
agent of the owner. I agree to comply with city sad state laws m
ATTENTION
iatlug conetructlon; and In doing the work authorized thereby, no De
will be employed In violation of the Labor Code of the Stale of Washin
THIS PERMIT
relating to Workmen's Compensation Insurance.
TYPE CONNE9T
-
IV R I --
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a
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pilled In six months.)
SIGNATURE (OWNER OR AGENT) DATE S10NEDINSPECTION
PERC. TESTN
I
Di E
tl !
W (
11
I
REMARKS
FIRE ZONE--
TYPE OF CONSTRUCTION
STREET IMPROVED
0 YES 0 NO
Thls Permit coven work to be done on private property ONLY.
Aoy eoastrnctiou on the public domain (carts, sidewalks, driveways,
mrquees, etc.) win verities separate pauh.lon.
a
SPECIAL INSPECTOR REQUIRED
GROUP
❑ YES L]NO
IOCCUPANCY
I
I I
I�
.
j'�j ❑ GAS
RESIDENTIAL LINE
NEW ❑ NON-RESIDENTIAL SIGN
ADD ❑ ❑ RETAINING
DEMOLISH WALL
❑ALTER El❑ EXCAVATE PENCE
OR FILL (.......... z .......... Fl.)
PLAN CHECKED HY THIS SITE IS LOCATED IN THE CITY
OF ED BE CODED LOCAL TAX
REMARKS U
i
C='_.v,! J,/ft^J /'� % �U"✓ '.J ��� % 7
REPAIR
❑ INSPMOVE
wim
POOL
NUMBER OF STORIES NUMHER OF
DWELLING
UNITS
NATURE OF WORK TO HE DONE
V¢luntl¢n
Fee RecciPt
No.
Plan Check No .....................
i
BUILDING
p
PROPOSED USE
PLUMBING
2 U
Q
PLOT PLAN (Indicate Building eetbacke, abutting streets)
HEAT A GAS LINE
FENCE
O
SIGN
RETAINING WALL
N
-
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
I
EXCAVATION OR FILL
i
--7,061
77971
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 apace provided.
DIRECTOR'S 13IONATURE
DATE r j
r - J�,----- -
INSPECTOR
f
TOTAL AMOUNT DUE
I hereby acknowledge that 1 have read thin application; that theI
formation given le correct; and that I am the owner, or the duly autlzed
agent of the owner. I agree to comply with city sad state laws m
ATTENTION
iatlug conetructlon; and In doing the work authorized thereby, no De
will be employed In violation of the Labor Code of the Stale of Washin
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Eicept DEMOLITIONS w
ONLY TILE
WORK NOTED
shall be completed lu nhtety days; MOVED -IN BUILDINGS shall be
pilled In six months.)
SIGNATURE (OWNER OR AGENT) DATE S10NEDINSPECTION
-
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
Thls Permit coven work to be done on private property ONLY.
Aoy eoastrnctiou on the public domain (carts, sidewalks, driveways,
mrquees, etc.) win verities separate pauh.lon.
a
--7,061
77971
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 apace provided.
DIRECTOR'S 13IONATURE
DATE r j
r - J�,----- -
INSPECTOR
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