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PERMIT APPLICATI®N
Inside Heavy Lines
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NAME (OR NAME OF BUBINE08)
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PORT of EDMo NDS
LOT CO 7e
LOT COVERAGE
ACTUAL
LOT COVERAGE
MAILING ADDRE69
5� 11 DIV Ilmi-
PERMISSIBLE HEIGHT
PROPOSED HEIGHT
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TELRPA ME NUMHk:R
ACTUAL LOT AREA
TOTAL BLDG.
CTP .5
T
77 05�}
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
REQURED IYARDS
PROPOSED YARDS
GAS
ElRESIDENTIAL LINE
NEW �
NAME
FRONT SIDE REAR FRONT 9IDI: REAR
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
LOCAL SALES TAX
LOT VARIANCE OR CONDITIO�N1AL E
NLEGAL
ADDRESS
C) YES NO PERMIT NUMBER /TD
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ADD RETAINING
DEMOLISH WALL
PLAG DE P AL
DATE.
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CITY
TELEPHONE NUMBER
14
REPAIR ❑ IN P. O SWIM
POOL
BT vV
EXISTIN STREET R/.. ............
F'f. DEFICIENCY THIS PROPERTY
NAME
'TOWN lf' CO uN TR r
VENC ,E
COMP. PLAN BT. R/ W ............FT.
FT.
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ADDRESS -
6'ly/O (]A�((U I r
REMARKS
CHECKED BY
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CITY
TELEPHONE
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NATURE OF WORK TO BE DONE �
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Fee Receipt No.
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Plan
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METER 8111E SERVICE SIZE
CLEARANCE
CHECXED BY
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STATE LICENSE NUM BE/R
CITY LICENSE NUMBER
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3 Doi. 3Yt DREMARKS
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PROPOSED USE f
Legal D-111111111 of Property 18b*1 Below or Altaoh Four CIPIe11
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aPLOT
TYPE CONNECTION
I VERIFIED BY
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REMARKS
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FIRE 20NE TYPE OF CONSTRUCTION STREET IMPROVED
YES [] NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
GAS
ElRESIDENTIAL LINE
NEW �
O YES 0 NO
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
LOCAL SALES TAX
®, NON-RESIDENTIALF� SIGN
OF EDMONDS.
SHOULD BE CODED 31.04.
ADD RETAINING
DEMOLISH WALL
REMARKS
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Yom, ALTER ❑ ORCFILLTE ❑ FEN Cz..........Ft.)
REPAIR ❑ IN P. O SWIM
POOL
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Pb'v / `-' "-amu"" Y /
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE �
Valuation
Fee Receipt No.
C �rG ` f /r Dal /
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Plan
OF ra/d4,�w1l �Q or114R
Check No .....................
BUILDING
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PROPOSED USE f
PLUMBING
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aPLOT
PLAN (Indicate Building setback., abutting streets)
HEAT A GAB LINE
E
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FENCE
2 r v
BION
RETAINING WALL
N
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
DUE
2
I hereby acknowledge that I haverend this application; that We In-
TOTAL AMOUNT
-co
p�
Ibrmallen given 1. correct; and that I am the owner, or the duly aulhe
Iced agent of the owner. I agree to comply with city and state laws regu•
ATTENTION
APPLICATION APPROVAL
Iall.g Obstruction; sad 1. doing the work authorized thereby, no person
will be employed In violation or the Labor Code of the State of Washington
TIU3 PERMIT
This application is not a permit until
relating to workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or Ills Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORN NOTED
uty; and fees are paid, and receipt is ac -
shall be completed In binety days; MOVED -IN BUILDINGS Stall be Co.-
Imowledged in space provided.
pieled la as mobtN.d
SIGNATURE I0 1' OR AGENT)
DA'�T/E IGNED
INSPECTION
DIRECTO 'B BIO
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DEPARTMENT
NOTE: AQQjieast Subject to Plan Check Fee
CITY OF
EDMONDS
PA g-3107
DATE
This Permit raven work to be done oa Drlvrte Property ONLY.
oa the paktib domain (rorbA, sidewalks, driveway=
FILE
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RECORD -OF INSPECTIONS -~
Date Passed......
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Foundation ----
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Plumbing (Partial)
(Rough)
r Frame
Furnace & Fuel Lines
Final
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