750122.pdfBUILDING DEPARTMENT Applicant FB ONE PERMIT
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---' PERMIT APPLICATION I Inside Heavy Lines JOB
ADDRESS [yr
;? I NAME (OR NAME OF BUSINESS) T J I ( -
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PERMISSIBLE HEIGF PROPOSED HEIGHT
NEW
IN RESIDENTIAL
❑
LINE
[y
ADD
ALTER
ElNON-RESIDENTIAL
❑ SIGN
KING
❑ WALL
❑ DEMOLISH
EXCAVATE
G PROPOSED USE
6�IV,
PLUMBING
❑ On FILL
Ir
(,,,,NL,,.]t_........Ft.)
FRONT SIDE REAR FRONT .IDE REAR
REPAIR
IOVE
❑ PnE-INSP.SWI
O
'I
POOL
(UMBER OF STORIES NUMBER OF
LEGAL LOT VARIANCE OR CON 1 IONAL USE
a YES 0 NO PERMIT NUMBER
YJ'ROVAL
DWELLING
I
HEAT & GAS LINE
PLANNING DEPT. DATE:
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UNITS
s
PERMISSIBLE HEIGF PROPOSED HEIGHT
0Z
,/
(T I
[y
aCTVAL LOT AREA TOTAL BLDG, AREA
)
♦1 U�)a
�
G PROPOSED USE
6�IV,
PLUMBING
REQUIRED YARDH P OPOBED YARD.'
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FRONT SIDE REAR FRONT .IDE REAR
- y
71;' i5'
ZPLOT
LEGAL LOT VARIANCE OR CON 1 IONAL USE
a YES 0 NO PERMIT NUMBER
YJ'ROVAL
PLAN (Indicate Building setbacks, abutting atreets)
HEAT & GAS LINE
PLANNING DEPT. DATE:
I
L
s
STREET R/W
EXISTING STREET R/ DEFICIENCY THIS PROPERTY
0
o�
COMP. PLAN ST. R/ .. .. ....Q...FT.
[.7
REMARKS Driveway slopes not to exceed those
C
SIGN
indicated on Standard DwIz. No. 103
z
�
J)I
1
P<
CIHEC ME BY
RETAINING WALL
A�tl L
IIETER SIZE
SERVICE SIZE
CLEARANCE
CHEQED BY
I
I
(�
DEMOLITION
I
REMAItIIa
e
_
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1
FYPE CONNECTION
VERIFIED BY
I
FERCFERC. TES
PERMIT NUMBER
a.
,
I
A
REMARKS
W
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
1
l
� YES E3 NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
] YES ❑ NO
I hareby acknowledge that I have read this application; that the ln-
PLAN CHECKED .. THIS
SITE IS LOCATED IN THE CITY
farmatlan given Is correct; and that I am the owner, Or the duly author -
OF EDMONDS. LOCAL SALES TAX
Fce
Plan Check N
[y
BUILDING
'
G PROPOSED USE
6�IV,
PLUMBING
I
ZPLOT
PLAN (Indicate Building setbacks, abutting atreets)
HEAT & GAS LINE
1
o�
FENCE
8 Z
SIGN
J)I
1
P<
RETAINING WALL
u�
C
SWIMMING POOL
,
(�
DEMOLITION
I
PRE -MOVE INSPECTION
S..
EXCAVATION OR FILL
A
�J
TOTAL AMOUNT ➢I)E
I hareby acknowledge that I have read this application; that the ln-
.00 0 D
farmatlan given Is correct; and that I am the owner, Or the duly author -
(zea agent of the owner, i agree to comply with city and elate Inmos regu-
ATTENTION
APPLICATION APPROVAL
lating canstructlon; and In doing the work authorized thereby, no person
will be employed In Violation of the Labor Code of the State of Washington
THIS PER311T
This application is not a permit until
relating to Workmen's Compensation Imuradam.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TRE
uty; and fees are paid, and receipt Is ac -
.hall be completed In nmOtY day.; MOVED -IN BUILDINOS shall be conn-
WORK NOTED
knowledged to space provided.
plated In el onths.)
SIGNATURE ONNEIt AGENT)
DATE lONE
INSPECTION
DIRECTO S10NATUIiFk
/ ,
DEPARTMENT
�'-/]Oj�r►
CITY OF
e
"07#7
EDMONDS
DATE
•:
Applicant Subject to Pldn Ieck de
.___-
775-2S25Any
his Permit Inure work la be done on prhate properly ONLY.
construction an the public domain (curbs, sidewalks, driveway.,
l
marquees, Or.1 will require ..parole permission.
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