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BUILDING
DEPARTMENT Applicant Fill
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PERMIT APPLICATION Inside Heavy Lines
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ADDRESS
NAME (OR NAME OF BU81NES8)
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PERNIdBIHLE .� ACT L n
LOT COVERAGE �LJ , LOT C.VE�AGE
MAILING ADDRESS
PERMISSIBLE HEIGHT`O / PI f)
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CITY TELEPHONE NUMBER
ACT A LOT A EA X'OTAL BL
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REQ IRED YARDS PROPOSE YARDS
QUI
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FRONT BIDE REAR FRONT BID REAR
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LEG LOT VARIANCE OR CONDITIONAL U E
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LA I DEP PP V DATE:
CITY TELEPHONE NUMBER
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EXISTIN STREET R/4J..Cd..�.FT. DEFICIENCY THUS PROPERTY
NAME
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COMP. PLAN ST. R/126 �' .Y.Fr. ._(J...FT.
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REMARx9 rDrVpW- s opes not to exceed those
AD— D Or
indicated on Standard Dwg. No. 103
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TELEPHONE NUMBER ER
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METER SIZE BE VICE SIZE CLEAR NCE
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§TATE LICENSE NUMBER
CITY LICENSE NUMBER
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R MARKS
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Legal Description of Properly (Show Below or Attach Four Copies)
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TYPE CONNECTION V R1FI D HY
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REMARKS
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FIRE 20N TYPE OF^C/q'NBTRUC/Tj(ON STREET IMPROVED
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E.❑ NO
SPECIAL INSPECTORREQUIRED OCCUPANCY GROUP
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RESIDENTIALLINE
❑ YES �iQ -� / "4--1
PLAN CHECK DY THIS SITE IS LOCATED IN THE CITY
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NEW
NON-RESIDENTIAL SIGN
OF EDMONDS. LOCAL SALES TAX
ADD RETAINING
H ULD BE CODED 31.04.
ARKS
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❑ DEMOLISH L]
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ALTER ❑ OR FILL ❑ ENCz..........Ft.)•��7�V
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REPAIR ❑ PR9 MOVE SWI d
❑ POOL
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dL�Jfl�-/ G�� �✓ /!J
NUMBER OF STORIES
NUMBER OF
DWELLING
Z
UNITS
NATURE OF WORK TO HE DONE
Valuation
Fee
Receipt
No.
Plan Check N. .....................
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BUILDING
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PROPOSED USE
PLUMBING
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PLOT PLAN (Indlcata Building eetbneke, abutting streets) 7-; 11'
HEAT & GAS LINE
FENCE
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SIGN
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WALL
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SWIMMING POOL
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DEMOLITION
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PRE -MOVE INSPECTION
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EXCAVATION OR FILL
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TOTAL AMOUNT DUE
�$ 5'9/
1 hereby acknowledge that I have rend this epDllenllon; that the 1n-
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formation given le correct; -a that I a n the own.-. or the duly aulhor-
Ized agent of the owner. I agree to comply with ell) and elate lawn reg.-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no person
will be employed In Violation of the Labor Cade of the Stale of Washington
THIS PERMIT
This application is not it permit until I ,
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY Till
WORK NOTED
uty: and fees are paid, and receipt i9 ac-
.hall be completed In ninety days; MOVED -IN BUILDINGS &hail be com-
knowledged in spacepr vlded.
pleted In elz months.)
d16NATUlt (OL EJt AGENT) DATE SIGNED
INSPECTION
IRE TOR'8 Bid TU
DEPARTMENT
7'
)
I
QITY OF�
.—NDS
ATE
N Applicant Subject to Plan Check Fee
775-2525
t1' 1•ennil cavero work to be done on private property ONLY.
Any consirnellnn no the public dnntoln (enrbn, nldew0.lkn, drlyex'ny.,
FILE
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