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Valuation
Fee Receipt No.
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Plan Check No .....................
BUILDING DEPARTMENT
Applicant Fill
ONPER
MBERR 740360
PERMIT APPLICATION
Inside Reavy Lines
JOB ,
ADDRESS
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PROPOSED USE
NAME (OR NAME OF BUSINESS)
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PERMISSIBLE �^ AOT' L u
LOT COVERAOEs LOT COVERAGE
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%
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MAILING ADDRESS
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PERMISSIBLE HFIOHT PROPOSED HEIGHT
CITY
NUMBER
ACTUAL LOT AREA TOTAL BLDG. AREA
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REQUIRED YARDS PROPOSED YARDS
NAME
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FRONT 8IDE REAR FRONT HIDE REAR
SIGN
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ADDRESS
LEGAL LOT VARIANCE CONDITIONAL USE
0 YES E3NO PERMIT NUMM BER
PLANNING DEPT. APPROVAL DATE:
CITY
TELEPHONE NUMBER
SWIMMING POOL
DEMOLITION
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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COMP. PLAN 8T. R/W ............FT. ............FT.
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REMARKS
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TOTAL AMOUNT DUE
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formation given Is correct; and that I nm the owner, or the duly author -
ADDRESS
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oily and state laws regu-
lees agent tr the owner. I aerie to comply authorized
latingconstruction; and to doing the work nuthorixad thereby,
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CITY
TELEPHONE NUMBER
CHECKED BY
AUTHORIZES
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NOTE: Permit Limit One Year DEMOLITIONS
METER
Signed by the Building Official or his Dep -
(Ezcept which
be completed
WORK NOTED
STATE LICENSE NUMBER
CITY LICENSE NUMBER
HILI•.
SERVICE SIZE CLEARANCE
CHECKED BY
Legal Description of Property (Show Below or Attach Four Copies)
REMARKS
provided.
SIGN I2E (OWNER OAA NT), ,
DATE SIGNED
INSPECTION
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TYPE CONNECTIONERIFIED
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CITY OF
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EDhIONDS
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FERC. TESTPERMIT
NUMBER
775-$525
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REMARKS
Aiy' cunei curl inn onIld 1k.,
the public Ammaln (cnrbn, nldrwnikn, drlvewayn,
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
JiVuea•v, ctc.) x111 r circ per'I" a.
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❑ YES NO
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SPECIAL INSPECTOR REQUIRED I OCCUPANCY GROUP
❑ YES El NO
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RESIDENTIAL GAS
❑ NEW ❑ LINE
❑ NON-RESIDENTIAL ❑ s1GN
❑ nnn RETAINING
❑ DEMOLISH E]WALL
❑ ALTER EXCAVATE FENCE
❑ OR FILL ❑ (........-x..........Ft.)
❑ REPAIR ❑ N PRE -MOVE ❑ SWIT
POOL
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHO LD BE CODED 3104
REMARKS
NUMBER OF STORIES
I ''UMBER
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Valuation
Fee Receipt No.
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Plan Check No .....................
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BUILDING
PROPOSED USE
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PLUMBING
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a PLOT PLAN (Indlcnto Bu -mi; setback., abutting street.)
HEAT & GAS LINE
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FENCE
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SIGN
RETAINING WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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TOTAL AMOUNT DUE
I hereby aeY.nowledgo that I have rend this application; that the In-
formation given Is correct; and that I nm the owner, or the duly author -
r
oily and state laws regu-
lees agent tr the owner. I aerie to comply authorized
latingconstruction; and to doing the work nuthorixad thereby,
no yerson
person
will be employed In violation of We Labor Code of the State of Washington
relating to Workmen's Compensation
THUS PERMIT
This application f9 not a until
Insurance.
AUTHORIZES
permit
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NOTE: Permit Limit One Year DEMOLITIONS
ONLY TILE
Signed by the Building Official or his Dep -
(Ezcept which
be completed
WORK NOTED
uty; and fees are paid, and receipt is ac-
ehall In ninety days; MOVED -IN BUILDINGS shall be com-
llnowledged in apace
pleted In sly....the.)
provided.
SIGN I2E (OWNER OAA NT), ,
DATE SIGNED
INSPECTION
DIRECJr 'B
DEPARTMENT
CITY OF
EDhIONDS
----
NOTE: Applicant Subject to Plan Check Fee
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775-$525
This Permit coven work to be done on private property ONLY,
Aiy' cunei curl inn onIld 1k.,
the public Ammaln (cnrbn, nldrwnikn, drlvewayn,
JiVuea•v, ctc.) x111 r circ per'I" a.
FILE