740329.pdfI
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BUILDING DEPARTMENT I Appueant Flu / BBYUMBER
PERMIT APPLICATION Inaldo IleaYy Linos ADDRE88 _
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740329
PA
ADDLEGAL
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HC4Ur[81 YAHUn rrt✓r D z FRONT SIDE REAR FRONT BIDE REAR
LOT VARIANCE OR CONDITIONAL USE
0 YES Cl NO PERMITNUMBER�J/�I�
PLANNING DEPT. APPROVALI`E /T DaCFsR L/
%
Fl RE ZOTYP F CONSTRUC(TTI�O-N''�,t STREET IMPROVED
DPW
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OEXISTI R LV EXIeTIN6 STREET R/W ............FT. DEFICIENCY TH28 PROPERTY ISNAME
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YES [3 NO
PLAN ST. R/W ............FT. ............FT. Ir?
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6 WN (satREMARKSGADDRESS
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I OCCUPANC 1 OUP
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RESIDENTIAL
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CITY
TELEPHER
CHECKED BY
fibZ5¢OMETER
NEW
SIZE SERVICE BIZ. CLEARANCE CHECKED BY
STATE LICENSEE UMBER
CITY LICBER.
It �'�
!W O �
Dcecrlpl/lon a( Property (Show BoloW or Attach)
REMARGKsLegal
BLDGt-, Se�/>I�G � OPe 1970
ler"
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Fl RE ZOTYP F CONSTRUC(TTI�O-N''�,t STREET IMPROVED
DPW
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YES [3 NO
-
SPECIAL INSPECTOR REQUIRED
E]YES NO
I OCCUPANC 1 OUP
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RESIDENTIAL
®❑
GA9
LINE
PLAN CHECXED BY
NEW
THIS SITE IS LOCATED IN THE CITY
❑ NON-RESIDENTIAL
OF EDMONDS. LOCAL SALES TAX
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SHOULD BE CODED 31.04.
ADD RETAINING
El DEMOLISH NALL
REMARKS
❑ ALTER EXCAVATE FENCE
OR FILL L., ...........Ft.)
El
.......
SWIM
6D /
REPAIR ❑ TNSP.1fOVE El POOL
f"('y
•e` �/
NUMBER OF STORIES
NUMBER OF
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,
�
DWELLING
UNITS
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NATURE OF
/Check
Valuation
Fee
Receipt No.
�GGVf•./erf� %♦/-�ll� �[, / l
Plan No._ ..........
BUILDING
4 PROPOSED USE
PLUMBING
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PLOT PLAN Building streets)
LINE
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(Indicate setbacks, anuttln6
HEAT A GAS
e
PENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hcreky acknowledge that I have read this application; that the In.
'
formation d, given le correct; and that I athe owner, or the duly autbor-
Ized agent of the owner. I agree to comply with city add elate law. raga-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no Damon
will be employed In Violation of the Labor Code of the Stale of Wuhington
TNS PERMIT
This application 1s 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-
_ -`-'"-'-'
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
knowledged in space provided.
pleled In sl. month..)
SIGNATUI O{VNEK OR AGENT)
DATE SIGNED
INSPECTION
DIRECTOR'S Sf0 U E
(
DEPARTMENT
CITY OF
NOTE: plicant Subject to Plan Check Fee
EDMONDS
DATE
775-2525
This Pennit c work io be don n private pro petty ONLY.
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