740441.pdf4
BUILDING
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PROPOSED USE
a-10,
PLUMBING
-
aPLOT
iUSE
HEAT & GAS LINE
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SIGN
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RETAINING WALL
BUILDING DEPARTMENT Applicant Ftll
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SWIMMING POOL
PERMIT APPLICATION Inside Heavy Lllie6
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DEMOLITION
ADDRESS
EXCAVATION OR FILL
NAME NAME OF/B/UBtNE/Ht8)
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Iher eby acknowledge that I have read this application; that the In.
TOTAL AMOUNT DUE
/
/(OR
LOT CO01BLE 5 LOT CO
LOT COVERAGE LOT COYESiAOE
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... agent oI the owner. I agree to comply with city and state laws regu•
ATTENTION
MAILING ADDRESS
O
ty
1
PEfthlltltllIILE HEIGHT PROPOSED fIFdOHT
will be em played In violation of the Labor Code of the Stale of Wvhington
Sia! iy she Say.
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTIIOIUZF,S
signed by the Building Official or his Dep -
CITY
TELEPHONEyNUMBER
ACTUAL LOT AREA TOTAL BLDG. AREA
uty; and fees are paid, and receipt is ac -
.hall be completed In ninety days; MOVED -IN BUILDINGS shall be com•
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Ideted In sig month..)
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REQUIRED YARDS PROPOSED YARD"
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
NAME
FRONT BIDE REAR FRONT BIDE REAR
DEPARTMENT
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WADDRE88
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LEGAL LOT VARIANCE OR CONDITIONAL USE
PERMIT NUMBER
DA: TEIV
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NOTE,:Applicant Subject to Plats Check ler
0 YES NO
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CITY
TELEPHONE NUMBER
PLANNING DEPT. APPROVAL DATE:
Any construcRun on (lie public domain (curbs, sldewNks, delve i"..
STREET R/W
more...., etc.) x'111 reaeire .."mate perml..lon.
FILE
NAME
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
a
COMP. PLAN ST. R/W ............FT. ............FT.
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REMARKS
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ADDRESS
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TELEPHONE NUMBER
CHECKED BY
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CITY
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METER 8i'LE SERVICE SIZE
CLEARANCE
CHECKED BY
STATE LICENBD NUMBER
CITY LICENSE NUMBER
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Legal Description of Property (Snow Below or Attach Four Copies)
REMARKS
TYPE CONNECTION
VERIFIED BY
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(Or
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PERC. TEST
PERMIT NUMBER
WI
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REMARKS
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F
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 YES 0 NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
RESIDENTIAL GAS
❑ LINE
❑ NEW
0 YES 0 NO
I
i
P LAN CHECKED BY THIS
SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL ❑ SIGN
OF EDMONDS, LOCA SALES TAX
ADD RETAINING
9E CODED 31L
REMARKS
DEMOLISH WALL
0 ALTERElOEXCAVATE jam( FENCSaE `/
e
Fence requirements - section 12.14.040
R FILL �f
❑ REPAIR D PRE -MOVE �Vt ''
INSP. E] POOL
attached.
NUMBER OF STORIESI NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Valuation
Fee
Racelpl No.
Plan Check N. .....................
4
BUILDING
[Oy w
n,
PROPOSED USE
a-10,
PLUMBING
-
aPLOT
PLAN (Indlcnt0 Building setback., abutting street.)
HEAT & GAS LINE
FENCE
So Q �r 0 Z)
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Iher eby acknowledge that I have read this application; that the In.
TOTAL AMOUNT DUE
/
formation at... Is correct; and that I nm the owner, or the duly author•
... agent oI the owner. I agree to comply with city and state laws regu•
ATTENTION
APPLICATION APPROVAL
Inline construction; and In doing the work authorized thereby, no person
will be em played In violation of the Labor Code of the Stale of Wvhington
THUS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTIIOIUZF,S
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (E.cePt DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac -
.hall be completed In ninety days; MOVED -IN BUILDINGS shall be com•
knowledged in space provided.
Ideted In sig month..)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DIRE R'B aGNATUR
DEPARTMENT
9•-_��.._�[,-2—a
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Y
•
CITY OI('
it
DA: TEIV
NOTE,:Applicant Subject to Plats Check ler
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775-2525
This Pernill covers tasb
k to . dune on Private properly ONLY.
Any construcRun on (lie public domain (curbs, sldewNks, delve i"..
more...., etc.) x'111 reaeire .."mate perml..lon.
FILE