750100.pdfrtKMI I APPLILAI IUIVI Ineldo Eleavy Linea
AD
NAME (Oft NAME OF 8U81N )
ADDRESS
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PLRMIBBIBLE
LOT COVERAGE
UAL a
N MA NO ADDRESS
LOT COVERAGE
Pk,Rh1I80IBLE HEIOFtT
PROPOSED HEIGHT
d
O
'G
CIT TE H NE NUMBER
ACTUAL LOT AREA
TOTAL BLDG. AREA
{
t!x
NAME
REOU/RED YARD.
PROPOSED YARDS
W
FRONT BIDE
REAR FRONT BIDE REAR
WADDRESS
LEGAL LOT
VARIANCE OR CONDITIONAL USE
YE8 NO
PERhfIT NUMBER
CITY
TELEPHONE NUMDER
PLANNING DEPT. APPROVAL DATE:
STREET R/W
NAME
EXISTING STREET R/W ............p -P. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............F1'. ............FT.
C
W
ADDRESS
REMARKS
LcL
z
C CITYI
TE LEPHONE NUMBEa
CHECKED -BY-
I�
p�it
U
STATE LICENSE NUMBER
CITY LICENSE NUMBER
METER eIL6
SERVICE SIZE CLEARANCE
CHECKED BY
I.
�
I
REMAI;KB
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Legal Description of Property (Show Below
or Attach Four Coples)
/
TYPE CONNECTION
VERIFIED BY
i
I
PERC. TEST
PER NUMBER
6,
W
O
RENARKa
+
Ind li
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FIRE ZONE I TYPE OF CONSTRUCTION STREET I➢1PROVED
i
[3 YES � No
SPECIAL INSPECTOR REQUIRED
OROUP
i
I
❑RESIDENTIAL
NEW
❑ GAB
LINE
❑ YES NO
IOCCUPANCY
;.
PLAN CHECKED BY
THIS
SITE IS LOCATED IN THE CITY
El nDn
NON-RESIDENTIAL
1:1SIGN
OF EDMONDS. LOCAL SALES TAX
SHOULD
RETAINING
DEMOLISH WALL
REMARn.
BE CODED 31.04.
ALTER EXCAVATE
Fence
❑ OR FILL ®
_ requirements
— section i 2 14 040.
fF/E�t�E
0 REPAIR ❑ PRE•SIOVE BM➢f
INSP. POOL
attached.
I 1
NUMBCIi O1 STOI;IF.S NUAIDER OM
1
DW ELLINO
I
UNITS
NATURE OF WORK T E DONE
,
h�.Ll,J
Valuation
Fee Receipt No.
,
Pian Check Na .....................
7
F
BUILDING
'
5, PROPOSEDUBE
aPLOT
PLUMBING
PLAN (Indlcato B mmg ectbncke, abutting etrrris)
HEAT & GAS LINE
9
FENCE
ho--�
V
tm13
BI ON
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
O
I hereby acknoWiedgo that I heve read this application; that the In.
formation given le correct; and that I am the owner, or the duly author-
`
Ized agent of the owner. I agree to comply with city and state laws regu•
Ialing conetructlan; and 1a doing the work authorized thereby, mo Darton
ATTENTION
APPLICATION APPROVAL
will be,
e employed In vlolatlon of UIe Labor Cade of We Slate of Washlmgton
THIS PERMIT
ralnllmg to Workmen•a Compensation Insurance.
application Is not a perinit until
NOTE: Permit Limit One Year
AUTHORIZESThis
ONLY THE
signed by the Building Official or his Dep-
(Except DEMOLITIONS which
shall he completed In alaety days; ➢/OVED-IN BUILDINGS
WORK NOTED
uty; and fees are paid, and receipt is ac-
Shall he cors.
pleted In six months.)
knowledged In apace provided.
e1GNA RE '::Z AGENT) DATE SIGNED
INSPECTION
D TOR•e
DEPARTMENT
J %5
CITY OF
heck Fee
NOTEcoven Sbe aat -property
EDMONDS
DArEy
^�
I
This Permit work t done on prlbjedto
ONLY.
775-2525
Any construction an the public domain (curbs, aldeWelk., drirewaya,
mnraures, rlr.) will rrumll eeprtrrtlr prrmlenion•
FILE
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