740286.pdfU
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C CITY I T:
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V STATE LICENSE NUM
�Z3"02- 5267
1 Lcaal Description of Property (Show Below or
—632- )
Plan Check No .....................
RESIDENTIAL
F_�
GAS
LINE
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NEW
10
NON-RESIDENTIAL
❑
SIGN
ADD
.
DEMOLISH
❑
RETAINING
I
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i
E
❑
PLAN (Indicate Building setbacks, abutting streets)
❑
OR FILL
BUILDING DEPARTMENT
Applicant FW
DBE
ZONE
PERMIT 740286
NUMBER
❑
INSPn10VE
El
POOL
iUhIHER OF STORIES
PERMIT APPLICATION
I Inside Heavy Lines
tRETAINING
JOB
ADDRESS
DWELLING
N
L�/�I/"+—'�
UNITS
SWIMMING POOL
NAME IOR NAME OF BUSlNE881
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PE COVERAGE A
LOT CO
AOT
LOT CO VERAGE
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EXCAVATION OR FILL
xMr MAILING ADDRESS
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PEIth11Se78LE HEIOklT PROPOSED HElOHT
ACTUAL LOT AREA TOTAL BLD.. AREA
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10 •
C ADDRESS w
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C CITY I T:
F
V STATE LICENSE NUM
�Z3"02- 5267
1 Lcaal Description of Property (Show Below or
—632- )
FRONT BIDE REAR FRONT BIDE REAR
LEGAL LOT VARIANCE OR CONDITIONAL UBE
0 YES ❑ NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
❑ YES [3 NO
Cj YES ❑ NO
OF EDMONDS. LOCAL SALES TAX
Valuation 1 Fee
Plan Check No .....................
RESIDENTIAL
F_�
GAS
LINE
E]
NEW
10
NON-RESIDENTIAL
❑
SIGN
ADD
DEMOLISH
❑
RETAINING
PLUMBING
ALTER
E
❑
PLAN (Indicate Building setbacks, abutting streets)
❑
OR FILL
`ENC. .......... Ft.)
ElREPAIR
❑
INSPn10VE
El
POOL
iUhIHER OF STORIES
NUMBER OF
SIGN
tRETAINING
WALL
DWELLING
N
UNITS
SWIMMING POOL
FRONT BIDE REAR FRONT BIDE REAR
LEGAL LOT VARIANCE OR CONDITIONAL UBE
0 YES ❑ NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
❑ YES [3 NO
Cj YES ❑ NO
OF EDMONDS. LOCAL SALES TAX
Valuation 1 Fee
Plan Check No .....................
Z
__—
,O„
BUILDING
PROPOSED USE
a
PLUMBING
V
ZPLOT
PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
N
FENCE
SIGN
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
aa 1
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PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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I hereby acknowledge that I have read this application; that the In.
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t
formation given Is correct; and that I am the owner, or the duly author-
,
Iced agent of the owner. I agree to comply with city and state laws regu.
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorlred thereby, no person
will be employed In violation of the Labor Code of the Slate of Washington
THIS PERMIT
This application is not a permit until
relating to workmen'. Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
uty; and fees are paid, and receipt Is ac-
ehall be completed In ninety d :)MOVED -IN BUILDINGS shall he Som.
Itnowledged in space provided,
pleted In six months.) j
SIGN U O1 O A E ) DATE SIGNED
INSPECTION
DIRECTO 8l0 T RE
DEPARTMENT
l
CITY OF
EDNIONDS
nwTE
NOTE: AQQljcant Subject to Plan Check Fee
775-2525
This Permit rn\'en work to be done on private property ONLY.
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