740515.pdfPERMIT APPLICATION I Inside heavy Lines
NAME (OR NAME OF BUSINESS)
MAILING ADDRESS
TELEPHONE NUMBER
i
i)ME
C ADDRESS
M CITY TO NUMBER
Z
O
AD a 0-10
ADDRESS
PERM1tlS1HLEUAL J
LOT COVERAGE oI COV RA E
PERMISSIBLE HEIGHT PROPOSED HEIGHT
ACTUAL LOT AREA TOTAL BLDG. AREA
REQUIRED YARD" PROPOSED YARDS
FRONT BIDF. REAR FRONT SIDE REAR
LEGALLOT VARIANCE OR CONDITIONAL USE
n YE9 I1 NO PERMIT NUMBER ,
PLANNING DEPT. APPROVAL DATE:
STREET R/W
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
DEFICIENCY THIS PROPERTY
............FT.
REMARKS
RESIDENTIAL
CHECKED BY
METER SIZE
I SERVICE SIZE
I CLEARANCE
CHECKED BY
REMARKS
E Cel- Tib CSE ►2�c-t ov
TYPE CONNECTION
I VERIFIED BY
PERC. TEST
I PERMIT NUMBER
REMARKS
CA`♦�
Fla: "1'ZYei Vp"yVlVl
STREET IMPROVED
YES [] NO
SPECIAL INSPECTOR REQUIREDOCCUPANCY •ROUP
RESIDENTIAL
6A8
0 YESNO
I `� Z
I
NEW
LINE
PLAN CHECK D BY
THIS SITE IS LOCATED IN THE CITY
{
NO
❑ SIGN
OF EDMONDS. LOCAL SALES TAX
ADD
RETAINING
REMARKS
SHOULD BE CODED 31.04.
® DEMOLISH E] WALL,r`
ALTER ❑ EXCAVATE [:] FENCE
OR FILL L....... x
1a•1�
�J
. ..........Ft.)
PRE-._
❑
IN
`` ,F-
`b� /
l _e\�)t�►
REPAIR ❑
❑ POOL
NUMB OF
NUMBER OF STORIES I DWELLING
DWF.LLI
UNITS
NATURE OF O BE DONE„,o///�.d
Valuation
Fee Rccelpt No.
-
tIL�Yt�•U/C_V-+"'�
Plan Check No.. ...................
I jJ
7
BUILDING
1
(Oy
Y PROPOSED USE
PLUMBING
_
Q PLOT PLAN (InJlcato Building setbacks, abutting streets)
HEAT e< GAB LINE
FENCE
I
SIGN
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
, DU
PRE-a10VE INSPECTION
EXCAVATION OR FILL
W
TOTAL AMOUNT DUE
1 Hereby acknowledge that I have reed this application; that the In-
formation given Is correct; and that I am the owner, or the duly author-
IUed agent of the owner. I agree to comply with Illy and .tete Iawe regu-
ATTENTION
APPLICATION APPROVAL
lating constmetlon; and In auto, the work autharlred thereby, no parson
will be employed In Aolallon of the Labor Code of the State of Washington
THIS PERMIT
This application Is not a permit until
relating to Workmen's Compensation Insurance.
AUTIIORIZES
e1gR¢d by the Building OffIC161 Or his Dep-
NOTE: Permit Limit One Year (Excopt DEMOLITION" which
ONLY TILE
WORH NOTED
Ili and fees are paid, and receipt is ac-
Y; P
+ —'�—
shall ba completed In Nnety days; a10VED-IN BUILDINGS shall be cam-
11nowledged in space provided.
'
pleled In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DIRECTOR' 1GN 49
DEPARTMENT
CITY OF
EDMONDS
DATE
NOTE: Applicant Subject to Plan Cbeck Fee
775-2525
This Permit corers work to be done an Private property ONLY.Any
conatrnetl,m on the public dontnin (curbs, rldrwalke, drlverrsye,
FILE
,rnllr„r. , ,,III r.,julre neparnir nrrllll.nian.
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