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Plan Check No .....................
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BUILDING DEPARTMENT
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APPLICATION
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ACTUALOdLOT
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SWIM
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NUMBER OF
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SWIMMING POOL
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ACTUAL LOT AREA
TOTAL BLDG. AREA
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FRONT HIDE REAR FRONT -BIDE REAR
LEGAL LOT VARIANCE OR CONDITIONAL UHE
O YES 0 NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
STREET H/W p �.
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY '/P,
COMP, PLAN ST. R/W ............FT. ............FT. W
REMARKS
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METER SIZE I SERVICE SIZE I CLEARANCE CHECKED BY
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:PE OF CONSTRUCTION
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NO
YES [] NO
SALES TAX
Plan Check No .....................
RESIDENTIAL
F-1
GAS
LINE
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NON-RESIDENTIAL
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BUILDING
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PROPOSED USE
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SWIM
iUMBF.R OF STORIES
NUMBER OF
SWIMMING POOL
DWELLING
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DEMOLITION
UNITS
PRE -MOVE INSPECTION
FRONT HIDE REAR FRONT -BIDE REAR
LEGAL LOT VARIANCE OR CONDITIONAL UHE
O YES 0 NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
STREET H/W p �.
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY '/P,
COMP, PLAN ST. R/W ............FT. ............FT. W
REMARKS
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METER SIZE I SERVICE SIZE I CLEARANCE CHECKED BY
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REMARKS /j jA F
YES
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:PE OF CONSTRUCTION
'OR REQUIRED I OCC[
NO
YES [] NO
SALES TAX
Plan Check No .....................
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BUILDING
PROPOSED USE
PLUMBING
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M PLOT PLAN (Indicate Building setbacks, abutting Street.)
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DEMOLITION
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TOTAL AMOUNT DUE
I hereby acknowledge that I have read this applies IS.; that the In.
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formation given I. correct; and that I am the owner, or the duly author.
Iced agent of the owner. I agree to comply with city and slate laws regu-
ATTENTION
APPLICATION APPROVAL
lacing construction; and in doing the work authorized thereby, no person
wlll be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
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relating to Workmen'. Compensation Imurance.
AUTHORIZES
signed by the Building Official or his Dep-
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NOTE: Permit Limit One Year (Except DEMOLITION8 which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
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.hall be completed In ninety days; MOVED -IN BUILDINGS Shall be com.
Imowledged in space provided.
plated In I. month..)
SIGNATURE IONNER Oli GENT)
DATE DN D
INSPECTION
DIREC R'S 81 NATURE
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DEPARTMENT
CITY OF
EDMONDS
DAT
NOTE: Applicant Subject to Plan Check Fee
775-2525
This Permit coven v.erk to be done on private property ONLY.
Any e-zrnation nn the public domain (turbo, .Id—lk.. &I—ar.'
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