740462.pdfPCLw/oaa (1 lie . 1.1,
CITY � TELEPHONE NUMBER
5a 5 -8631
NAME
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ADDRESS f
A44
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E�RMIeSIBL£
/ ACTUAL
T COVERAOE
CITY TELEPHONE NUMBER
LOT COVERAGE
PERDIISSIBLE HEIGHT
II
PROPOSED HEIGHT
ACTUAL LOT AREA
TOTAL BLDG. AREA
REQUIRED YARDS
PROPOSED YARDS
FRONT SIDE
REAR
FRONT SIDE REAR
LEGAL LOT
VARIANCE
OR CONDITIONAL USE
YES [3 NO
PERMIT NUMBER
EXISTING STREET R/W
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PLANNING DEPT. APPROVAL DATE:
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CITY TELEPHONE NUMBER
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PLANNING DEPT. APPROVAL DATE:
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CITY TELEPHONE NUMBER
II
STREET R/W
EXISTING STREET R/W
............FT. DEFICIENCY THIS PROPERTY
NAME
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COMP. PLAN ST. R/W
............FT. ............FT.
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REMARKS
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TELEPHONE NUMBER
I CHECKED BY
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METER SIZE
STATE LICENSE NUDi[[Bout
CITY LICENBE NUMBER
SERVICE
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SIZE
CLEARANCE
CHECKED BY
wol�tiCx "'Y'lIT
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Legal Description
REMARKS
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of Property (Show 511¢W or Attach Four copies)
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TYPE CONNECTION
VERIFIED BY
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RC. TEST
PERMIT NUMBER
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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YES [3 NO
SPECIAL INSPECTOR REQUIREDOCCUPANCY GROUP
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RESIDENTIAL
❑ OAS
❑ YES NO
NEW
LINE
PLAN CHECKED BY
THIS SITE 15 LOCATED IN
NON-RESIDENTIALEl
OIGN
THE CITY'
OF EDMONDS. LOCAL SALES TAX
❑ ADD
RETAINING
REMARKS
5H0 LD BE CODED 3104
DEMOLISH WALL
ALTER EXCAVATE FENCE
I
OR FILL (.....................Ft.)
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PRE -MOVE
REPAIR❑ SWIM
INBP. POOL
I
NUDIBER OF STORIES NUMBER OF
(
DWELLING
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UMTS
;I I
NATURE OF WORKJI'O HE DONE
A
Ynlu tion
Fee Receipt No.
Plan check N
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x
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BUILDING
PROPOSED UBE
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PLUMBING
aPLOT
PLAN (Indicate Building setbacks. abutting streets)
HEAT A GAS LINE
7
FENCE
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SIGN
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RETAINING WALL
IN
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SWIMMING POOL
DEMOLITION
+
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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TOTAL AMOUNT DUE
I hereby acknowledge that I have reed this appllentlon; that the In-
formation given le correct; and that I am, owner, or the duly author-
I
ized agent r owner. i agree to comply with cand state taws reg.-
tating conetructictlon; and In doing the work authorizrit ed thereby, no Dereon
ATTENTION
APPLICATION APPROVAL
will be employed In violation Of the Labor Code of the State of WaJWhich
TNA PER511T
relating t¢ Workmen's Compensation Insurance.
This application 1s not a permit until
AUTHORIZES
signed by the Building Official or his Dep -
NOTE:
NOTE: Permit Limit One Year (Except DEMOLITION
ONLY THE
fees
shall be completed In Idtaty days; MOVED -IN BUILDINGS shall
WORK NOTED
Uty; and are paid, and receipt is ac -
knowledged !n
pleted In six months,),BION
apace provided,
TUBE (OWNER Olt AGENTDATE
SIGNINSPECTION
D! R'e a ATDEPARTMENTCITY
OF
'NOTE: Applicant Subject to Plan Check Fee
EDMONDS
DATE
Q� ^ C7
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Thle Pe 'it o —1— work in be done on private property ONLY.
775-2525
/
Any eonelruction on tho public domain (curbs, sidewalks, driv.—ye,
ni.iran rrr. ric.) ,clll rnynlrr erpnrair pr ndsslon•
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