740435.pdf---_...._.__...__.�.._. .. _.... _.._... _......__
V.Ivstinn
RESIDENTIAL
BUILDING DEPARTMENT
AppllcantFlu
°NE
PERMIT APPLICATION
Inside Heavy Linos
aoB
ElNON-RESIDENTIAL
ADDRESS
SIGN
NA7� (OR AME OF US1NE8 )
ElADD
❑
3
MAl%/ ^ PBS F I t /
WAIJININC
LOT COVEAAI
pEFtM IS010LE
U
ag
6
0
FRONT SIDE REAR FRONT BIDE REAR
LEGAL LOT VARIANCE OR CONDITIONAL USE
CI YES 0 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
13 YES ❑ NO
[ YES E] NO
YLAN ..EO.ED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
NA'1'UItE UH' WURK 'lU HE DONE
V.Ivstinn
RESIDENTIAL
NEW
LINE
i
ElNON-RESIDENTIAL
❑
SIGN
I
ElADD
❑
❑
WAIJININC
PROPOSED USE
ALTER
DEMOLISH
E
❑
FENCS
HEAT & GAS LINE
❑
OROFILL
PLOT PLAN (Indicate Building setbacks, abutting streets)
.......... Ft')
FENCE
REPAIR
❑
IN RESP. -MOVE
❑
PPOOL
RETAINING WALL
1'I
NUMBER OF STORIESN
UMBER OF
II
DEMOLITION
DWELLING
PRE -MOVE INSPECTION
EXCAVATION OR FILL
UNITE
FRONT SIDE REAR FRONT BIDE REAR
LEGAL LOT VARIANCE OR CONDITIONAL USE
CI YES 0 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
13 YES ❑ NO
[ YES E] NO
YLAN ..EO.ED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
NA'1'UItE UH' WURK 'lU HE DONE
V.Ivstinn
Fse Reecipt No,
Iwl
i
tion catch No .....................
I
�
BUILDING
i
PROPOSED USE
PLUMBING
HEAT & GAS LINE
VVVV VVVV
PLOT PLAN (Indicate Building setbacks, abutting streets)
FENCE
SIGN
_
RETAINING WALL
1'I
SWIMMING POOL
II
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
•
��
AMOUNT DUE
by acknowledge that I have read this appllcallon; that the In.
I hereby
/ e O / / /
formation given Is correct; and that I nm the owner, or the duly author.
Iced agent of tae owner. I agree to comply with city and elate law. regu-
ATTENTION
APPLICATION APPROVAL
lating .aetrucRon; and In doing the Work authorized thereby, no person
Will be employed In ""alloo of the Labor Code of the Stale of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen'. Compensation Insured..
AUTHORIZES
signed by the Building Official or his Dep-
i
T e mit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is aC-
) led In ninety days; MOVED -IN BUILDINGS shelf be .m-
knowledged in space provided.
ontha•)
OWNER OR AOEN'1') DATE SIGNED
fiT.
INSPECTION
D TOR'H 816NAT AE
I
DEPARTMENT
/ `J
//❑��
_
CITY OF'TL(�
EDMONDS
ot
NOTE: Applicant Subject to Plan Check Fee
pt
Thl. Permit rovers cork to be Gone a n private Property ONLY.
%%.r/-2545
rnnsl nlrtlnn on the public domain (caths, eldrwalks, driveways,
FILE
:tar ulrr
etc.) ,alit reV nepnrnlr prrml.�lnn.