740396.pdfBUILDING DEPARTMENT AppllcantFiil ZEE
PERMIT APPLICATION Inside Heavy Lines ,oB
ADDS
NAME (OR NAME OF BUSINESS)
PER
C� IV I b Y�LI Cs1V'p LOT C
N MAILING RESS t—
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tTYTELEPHONE NUMBER ACTU
n,A �k o I h)Lv --K31
WADDRESS
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
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CITY
I TELEPHONE NUMBER
NAME
CCy��
METER SIZE
C ADDRESS
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REMARKS
C C
L ,i N LL)t, 0 C
TYPE CONNECTION
TELEPRONE NUMBER
'779- 9s 9
STAT LICENSE NUMBER
I PERMIT NUMBER
CITY LICENSE NUMBER
Legal Description of Properly (Show Below or Attach Four Copies)
FO
Y
W
[
FRONT SIDE REAR FRONT BIDE REAR
LEGAL LOT VARIANCE OR CONDITIONAL USE
YES [3 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.
"MARKS
� �
I
CHECKED BY
METER SIZE
I SERVICE SIZE
I CLEARANCE
CHECKED BY
REMARKS
TYPE CONNECTION
(VERIFIED BY
C. TEST
I PERMIT NUMBER
REMARKS
THIS SITE IS LOCATED IN THE CITY
�
...... ......� .r.. ...
....n o.nv....w. ...r. r.. ....ten.......
� �
I
YES [] NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
NEW
RESIDENTIAL
E] GAS
LINE
YES [] NO
THIS SITE IS LOCATED IN THE CITY
PLAN CHECKED BY
NON-RESIDENTIAL
[
OF EDMONDS. LOCAL SALES TAX
I
SIGN
SHOULD BE CODED 31.04.
i.
E] ADD ❑ RETAINING
WALL
REMARK.
DELIOLISH
ALTER
I
❑ OR FILLEXCAVATE
(.ENCx_........IY.)
t��
REPAIR ❑ SWIM
NSPPRE.h[OVE I I POOL
(�
Pel. •ter mL
D +' �`j
� 1 � `+ IP(L 19 J
NUMBER OF BTO321E8 A OF
DWELLING
UNITS
UNITS
OF WORK TO BE ONE
Valuation
Fs.
Receipt No.
(r�GTURE
l T \\i� �4. l l Y t1� uq
R ,
Plan cheek No.... .................
,,L
r .
BUILDING
�.
PROPOSED USE
...r
PLUMBING
O PLOT PLAN (Indicate Building eetbnek., abutting streets)
HEAT A GAS LINE
FENCE
_
1
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
'
EXCAVATION OR FILL
-
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this apDllcatlon; that the Irt-
1-matlnn given Is correct; and that I aca the owner, or the duly author -
,zed of the owner. [agree to comply with city and elate laws rage.
agconstruction;
ATTENTION
APPLICATION APPROVAL
ati
mting , eo person
and In doing the work flulhorized thereby,
will be employed In violation of the Labor Coda of the Stale or Waehington
THIN PERMIT
This application is not a permit until
relating to Workmen's Compensation Insursece.
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.
y,-_.---�'�-•�
.hall be comDle d In Neely deye: MOVED -IN BUILDINGS shall be cam-
knoWledged in space provided.
pleted In elg oI ha,)
t NE O AGENT]
DATE, SIGNED
INSPECTION
DIRECTOR' ION
=,O
DEPARTMENT
CEJ(
CITY OF
EDMONDS
DATE
E; Applicant Subject to Plan Check Fee
775-2525
This nail cocere work to bo done on prlcute property ONLY.
Any ry "N nlrtinn nn (lir pn Ulic domain (enrbe, nldew'olkn, drlrew'aye,
�rilu rr., rl r.l ..til ray uirr .cannLLr p••rnueaina,
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