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NAME (OR NAME OF BUSINESS)
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CITY TELEPHONE NUMBER
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NAME
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ADDREBBPERMISSIBLE
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LOT COVERAOEeLOT �I��LOT
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PERDNtltlIBLE HEIGHT
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ACTUAL LOT AREA/
LOT AREA/I'
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TAL B 0 AREA
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REQUIRED YAKDSREQUIRED
POSED YARDSPiVOrSrT/E. YARDS
FRONT HIDE REAR
FRONT SIDE REAR
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LEO LOT VARIA CE OR CONDITIONAL U8
.B O,PERMIT NUMBER
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TELEPHONE NUMBER
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EXIeTl STREET RIVA......... . DEFICIENCY THIS PROPERTY
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NAME
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COMP, PLAN BT. RrV.FT. �,FI'.
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REMARKS Drivewayslopes not to exceed those
indicated on Stndard Dwg. No. 103
A)DRESS
CHECKED BY
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I TELEPHONE NUMBER
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LICENSE NUMBER
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SERVICE SIZE
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CLEARANCE
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Leg 1 D /crrllptlon -of Property (Show Below or Attach Four Copies)
REMARKH
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PERC. TEST PERMJT,r NUMBER'
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REMARKS
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FIRE ZO TYPE OF CONSTRU TION STREET IDiPROVED
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SPECIAL INSPECTOR REQUIRED OCCUPA13j)Y GROUP
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RESIDENTIAL ❑ LINE
®, NEW
D NON-RESIDENTIAL B1cN
ADD RETAINING
ElDEMOLISH WALL
❑ ALTER EXCAVA E El FENCE
YES NO 7
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PLAN CHEC D THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
R RK9 SHOULD 8 CODED 31.04.
❑ OR ILLX......... .Ft.)
FREPAIR PRE -MOVE BWIDf
INSP. O POOL
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NUMBERSQOl• BTOR[Ftl
NUMBER OF
DWELLING O N�
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r / UNITS
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NATURE OF t1fgRK TO j E DO 0 Jam'
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Valuation
Fee Receipt No.
flan Check No- ...................
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PROPOSED USE
BUILDING
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PLOT PLAN (lnUlcnto Dullding eetbacke, abullln6 etrceta)
PLUMBING
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PENCE
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SIGN
RETAINING WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have rend this application; that the In.
format hereby
given Is correct; and that I am the owner, or the duly author.
Ired agent Of tho owner. I agree to comply with city and elate law. rogu.
lating construction; and In dol.g the work authorized thereby, ao person
will to employed In violation of the Labor Code of the State of Washington
relating to workmen's Compensation Ineurs.uw.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
mPleled In ninety days; MOVED -1N BUILDINGS .hall be com-
Meted In x month..)
/ �� /
TOTAL AMOUNT DUE 7 1
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE Ht and fees are 81d, and receipt is 6c-
WORK NOTED yi P p
knowledged in space provided.
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816NAT (OWN EN DATE 8✓3J0NED
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INSPECTION iRE BION TU
DEPARTMENT
CITY OF
This Pe hill Soren work to be done an private property ONLY.
Any construct,.. on file Public domain (curbs, sidewalks. driveways,
o,.,ra.rr,. rlr.l „III rrn.lrr sePnrulr nrr.�l,sl.n.
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EDbIONDB ATE
775-2525 /L 7
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