750159.pdfBUILDING DEPARTMENT USE
ONNE PERMIT
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Applicant Fill
PERMIT APPLICATION Inside Heavy Linea so��
ADDRESS
NAME {OR NAME OF BUBiNE88) p�
I� /C /is LOTPERCO ERA ACTUAL % ..
7FiA / (( �/ LOT COVERAGE LOT COVEItAOE
C MAILING ADDRESS /C
PERMISSIBLE HEIGHT PROPOSED HEIGHT/ O
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REQVIRED YA RDB PROP 9ED YARDS
FRONT BIDE REAR FRONT SIDE REAR
NAME
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ADDRESS
BUILDING
LEGAL LOT VARI NCG OR CO TIONAL U
PERMIT NUMBER
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to YES O NO
PLANTN(�� T. APP,f�OVAL DATE:
/T
A
C CITY
TELEPHONE NUMBER
STREET R/W R/W
PIRP'
El
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN 8T. R/W ............FT. ............ FT.
NAME
NUMBER OF STORIES
HEAT & GAS LINE
REMARKS
02 ADDRESS
0[.�
V
FENCE
I CHECKED BY
1'��
F CITY
TELEPHONE NUMBER
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MET. SIZE I SERVICE SIZE
I CLEARANCE I
ECXED BY
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NEW
ADD
ALTER
RESIDENTIAL
❑ NON-RESIDENTIAL
PER.. T
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BUILDING
REMARS
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PROPOSED USE
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FIRE ZO
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NATURE OF E'0,9IC TO EE
_/V k2 -YES El NO
IEDI OCCUPANCY GROUP
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THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
No.
NEW
ADD
ALTER
RESIDENTIAL
❑ NON-RESIDENTIAL
❑ LINE
slax
RETAINING
WALL
❑ FENC...........Pt.)
�PLANB
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DEMOLISH
❑❑
on FILL E
BUILDING
❑
PROPOSED USE
REPAIR
❑
PIRP'
El
SWIM
POOL
r,SLi
NUMBER OF STORIES
HEAT & GAS LINE
NUMBER OF
:, I
FENCE
DWELLING
I
SIGN
I
1
UNITS
I
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NATURE OF E'0,9IC TO EE
_/V k2 -YES El NO
IEDI OCCUPANCY GROUP
�L—
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
No.
PI¢n Check N. .....................
BUILDING
PROPOSED USE
PLUMBING
1
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
:, I
FENCE
SIGN
I
1
RETAINING WALL
I
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
it
i
TOTAL AMOUNT DUE
1 hereby acknowledge that I have rend t61s aDPllcatlan; that the In-
I
formation given le correct; and that I Am the owner, or the duly author-
I.
Ittd agent of the owner. I agree to a'mt•te with city and elate laws reg"-
ATTENTION
APPLICATION APPROVAL
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lating construction; and In doing the work authorlred thereby, be p .... n
wlll be employed in violation of the Labor Cade of the State of Washington
TIus rERMIT
This application is not a permit until
falsities to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (E..ept DEMOLITIONS which
ONLY TILE
WORK NOTED
Uty; and fees are paid, and receipt is ac-
.hall be completed In N.ely days; MOVED -IN BUILDINGS shell be cons-
knowledged in apace provided.
plated In at. menthe.)
IIGNATURE (OWNER Olt AGENT)
DATE SIGNED
INSPECTION
DIR 0 8 8IONATU
DEPARTMENT
_
CITY OF—
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
775-2525
Thl.I'ermlt c"ren work to be done on private property ONLY.
Any eenetrnr".. nn the puUllc dmm�ln (rueba, .11swelk., driv...ye.
FILE
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RECORD OF INSPECTIONS
Date Passed
Foundation --
Plumbing (Partial)
(Rough)
Frame S
Furnace.& -Fuel Lines-
Final
1