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BUILDING DEPARTMENT I Applicant Fill ZONE Nu BEITRTR 740554
PERMIT APPLICATION IRSidO Heavy Lines ADDRESS
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ADDXE88rr ll - C
ONE
V I O _ _ T'7 _NUMBER
_ I _ dam...._
NEW
Plan Check No. ....................
RESIDENTIAL
❑
LINE
�I
NON-RESIDENTIAL
❑
SIGN
ADD
❑
DEMOLISH
O
yALLKING
El ALTER
❑
FENC
❑
OROFILL
x- ........ Ft.)
REPAIR
❑
ISWIM
NSP.
V
POOL
UMBER OF STORIES
NUMBER OF
PLOT PLAN (Indicate Building setbacks, ab.ttl.g streets)
HEAT d: GAS LINE
DWELLING
b
O
FENCE
Q�1 n �
UNITS
'
I
PERMISSIBLE HEIGHT PROPOSED HEIGHT bO
ACTUAL LOT AREA TOTAL BLDG. AREA R
REQUIRED YARDS PROPOSED YARDS
FRONT SIDE REAR FRONT HIDE HEAR
LEGAL LOT VARIANCE OR CONDITIONAL USE
YES 0 NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
STREET R/W 0
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT. khk777
REMARKS x
O
Z
CHECKED BY
METER SIZE I SERVICE SIZE CLEARANCE CHECKED BY
[ym
REMARKS
r
TYPE CONNECTION I VERIFIED BY ,
❑ YES [] NO
SPECIAL INSPECTOR REQUIRED I OCCUPANCY GROUP
❑ YES ❑ NO
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
I
it
Valuation Fee Receipt No.
Plan Check No. ....................
�I
BUILDING
FO
0. PROPOSED USE'.
PLUMBING
V
PLOT PLAN (Indicate Building setbacks, ab.ttl.g streets)
HEAT d: GAS LINE
b
O
FENCE
Q�1 n �
nO
6/O —
'
I
SIGN
j
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
'
A /1
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
O^V
formation given Is correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to Comply with city and elate law, regu-
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
'.littler. to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
ut and fees are aid, and receipt is ac-
Yi P P
shall 6e completed In ninety days; MOVED -IN BUILDIN08 .hail be mm-
knowledged In space provided.
pleted In six months.)
-SIGNATURE (OWNER Oy\ AGENT)
yy
DATE SIGNED
INSPECTION
DEPARTMENT
DIRy OR'8 lONATU
/ �'
7
,-
ITY OF
CITY OF
111(14 '�ifr/" J'('� (;'
E
DAA -"r
NOTE: Applicant Subject to Plan Check Fee
_
This Permit ,u rs work to be done on private properly ONLY.
775.2525
- ll
Any .u.l 'u" "mon th. public domain (curb., sM-1k.. drlve—a
r1i ..III r Iulr,• .opo rol,• I,r•rml•.Inn'
FILE
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777