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USE
PERMIT U ,
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PERki1T APPLICATION Inside Heavy LWoe ,DB
ADDRESS
NAME (OR NAME OF BUSINESS)
i1 Art f' D M t LOT c tVERA LOT CO J � 1
/ a U r� r r 1 S IAT COVERAOE�e dy - z LOT COVE1lAOE
N MAILING
ADDRESS % r7eti G 1 ,
I? 3 0 6 1 j V V e 5� PERMItl81BLE HEIOjiv Pi;OYOeED ISEIO /
CITY J TELEPHONE NUMBER ACTUAL LOT gR�A TOTAL BLDO. ARE A
"Edirn0 h Vl ?H3' C1),�I% 17 Y /o8 I
REQUIRED YARDS PROP08F.D YARD j
NAME FRONTSIDE FRONT EAR
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LE AL LOT VARIANCE Ol; CONDITIONAL
N ADDRE88 JI YES 0 NO PERMIT NUMBER !
V PLANNIN7-Ty-
CITY
A OVAL 1JATE: �I
CITY TELEPHONE NUMBER 4.—
ee STREET R/\V e d �
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME
1 COMP. PLAN ST. R/W ............FT. ............FT. W
-��REMARKS 5k+
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ADDRESS u� 17 i
O � � � �� � � � �'e i � /✓/� CHECKED HY 61
4f CITY TELEPHONE NUMDFi,F; /
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METER 512E SERVICE 812E CLEARANCE C/ CKED BY
O STATE LICENSE NUMBER I CITY LICENSE NUMBER
( � P
Legal Description of Property (Show Below or Attach Four Copies) REMARKS
TYPE CONNECTION VERIFIED BY
CF
PERC, TEST PERMIT MBE" C
W
WQ REMARKS m
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A FIRE ZONE TYPE OF CONBTRU ION STREET IMPROVED
/ Cr*.. Ej NO
SPECIAL INSPECTOR REQUIRED I OCCUPANCY GROUP
CAS C] YES
a,"..
RESIDENTIAL ❑ LINE PLAN CHECKE DY THIS SITE IS LOCATED IN THE CITY
NEW OF EDMONDS. LOCAL SALES TAX i
NON-RESIDENTIAL ❑ SIGN � H ULD BE CODED 31.04.
❑ ADD ❑ DEMOLISH [jRETAI NG I MAR /J "�� I �r J
ElALTER EXCAVATE FENCE ,. d l 44 6 %df N f;_,(/ J 1._J
ALTER
FILL (..........z..........Fl.) _ r7f �^ ,/
PRE -
REPAIR ❑ SWIM
INSP." ❑ POOLf-Z' Ci l /G• y � %"� /N ��C/JQ�f '-
1 '
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURF FWORK D SE DO E Valuation Fee Receipt No,
Plan Cheek N. ..................... .
c
/�z7 (' DO -
C PROPOSED USE BUILDING V
U PLUMBING
PLOT PLAN (Indicate Building .etimeks abutting Street.) HEAT & GAS LINE --
A '
M
N
TOTAL AMOUNT DUE
FENCE
BION
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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TOTAL AMOUNT DUE
I hereby acknowled g. that I have read this application; that the 1n -
formalion given le correct; and that I an the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws rag'-
ATTENTION
APPLICATION APPROVAL
,aling construction; and In doing the work authorized thereby, no person
Will be employed In violation or the Labor Code of the State of Washington
TRIS PERMIT
This application Is not a permit until
rat I...to Workmen'. Compensation Inaurence.
AUTHO
Signed by the Building OPfIC1a1 or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITION8 which
ONLY TItIZEtlIIE
WORK NOTED
uty; and fees are paid, and receipt is ac -
.hall be completed In nasty days; ASOVED-IN BUILDINGS shall be coin-
knowledged In space provided,
Dlaled In six months.)
NONATU1tE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DRE OR's B10N TUR /
/ DEPARTMENT
2 s
Y,Laotl
-I
OITY DF
—
DATE
EDMONDS
NOTE: Applicant Subject to Plan Cbeck Fee
775.2525
This t'ernHl covers work to be dune on private property ONLY.
Any construrt Lon en the public domain (curbs. Sidewalks, drlveways,
FILE
marquees, etc.) will require Separate permission.
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