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740613
FilllPERMIT APPLICATION Inside Heavy LineJUDsADDRESS
NAM MBUStNEO —77 PERMISSIBLE ACTUAL
LoEnAOLOT COY
PElhllddlDLE HEIGHT PROPOSED HEIGHT
amAILING ADDRESS
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ADDRESS
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X F C31'Y I TELEPHONE NUMBER
L-�tifoNDS
STATE LICENSE NUMBER I CITY LICENSE NUMBER
ACTUAL LOT AREA TOTAL BLDG. AREA F.
REQUIRED YARDST PROPOSED YARDS a'
FRONSIDE REAR FRONT SIDE. REAR
LEGAL LOT VARIANCE OR CONDITIONAL USE
C3 YES I] NO PERMIT NUMBER i
PLANNING DEPT. APPROVAL yol"icr DATE:
STREET R/W 1
EXISTING STREET R/W ............ FT. DEFICIENCY TITIS PROPERTY x
COMP. PLAN ST. R/W ............FT. ............FT. '
REMARKH Drivemau slopes not to exceed those
EX/Sr
CTION I E I . BY
�Iy IPE I FIBER
i
resee� a1-, Say /c �
TYPE OF CONSTRUCTION STREE
O YES
PEC OR REQUIRED IOCCUPAN:rROUP
NO
ED BY THIS SITE IS LOCATED IN
OF EDMONDS. LOCAL 5
SHOULD H CODED 31.04.
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Valuation Fee
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RESIDENTIAL
❑
YN
❑
NEW
Ir�1
LINE
FT LAN
P
�O
BUILDING
NON-RESIDENTIAL
❑ SIGN
PLUMBING
ADD
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RE
❑
DEMOLISH
O yAT1.ALININC
PLAN (Indicate Building setback., b. ting street-)
HEAT A GAS LINE
ALTER
AVATE
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/
❑
OROFILL
FENCE
❑
REPAIR ❑
PRE -MOVE
SWI I
❑ POOL
'UMBER OF STORIESNUMBER
OF
N
6L
DWELLING
1
SWIMMING POOL
• - S-
UMTS
/
DEMOLITION
EX/Sr
CTION I E I . BY
�Iy IPE I FIBER
i
resee� a1-, Say /c �
TYPE OF CONSTRUCTION STREE
O YES
PEC OR REQUIRED IOCCUPAN:rROUP
NO
ED BY THIS SITE IS LOCATED IN
OF EDMONDS. LOCAL 5
SHOULD H CODED 31.04.
,`'62.N/T �/z fw•
Valuation Fee
`
Plan Check N. .....................
4
�O
BUILDING
e.
PROPOS BE U
PLUMBING
��a,,,,,,
aPLOT
PLAN (Indicate Building setback., b. ting street-)
HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
N
1
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
'
EXCAVATION OR FILL
I hereby acknowledge that I have mad this application; that the in.
TOTAL AMOUNT DUE
%_, O �/ •� j
t0 (0
formation given Is correct; and that I am the owner, or the duly nuthor-
Ittd "gaol tr the owner. I "gree to cc Ply with Illy and elate laws rogu•
Iating conettuctlgn; end m dolpg the
ATTENTION
APPLICATION APPROVAL
work authorised 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
relating to Workmen's Compensation Insurance.AUTHORI
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (ESCCPt DEMOLITIONS which
TZES
WORE NOTED
uty, and fees are paid, and receipt is ac -
.hall he completed In meaty days; 31OVED-IN BUILDINGS Shall be Sam•
knowledged in space provided.
plcled In elg months.)
SIGNATURE (OWNEI 11 AGENT) DATE SIGNED
INSPECTION
DIRECT A•a.,SIGNA RF
DEPARTMENT
t/G/
nU
CITY OF
EDOIONDS
DATE
NOTE: App rcdnt Subject to Plan Check Fre
(j
This Per11 roger. work to be done an privets property ONLY.
775-2525
Any eonslruclinn on the public domain (curbs, Sidewalks, driveways,
marquees, etc.) will require separate permission.
FILE
44�- 4573