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BUILDING DEPARTMENT Applicant Fal
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APPLICATION Inside Heavy Llnog
JOB
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PERMIT
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ADDRESS S•a
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NAME (OR NAME OF BU 1NEBB)
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PERMISSIBLE ^ A UAL /�
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LOT COVERAGE ..cry O/L, L T COVE,�2 11 /C f/
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MAILING ADDRESS
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PERMISSIBLE HEIGIITSO f PROPOSED HEIOHT� 1
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CITY
TELEPHONE NU��Mt1BCft
ACTUAL LOT A EA TOTAL B DO. AREA x
B .L Z
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{a REQUIRED YARDS PROPOSSEDl{Y1ARD8
/N
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ME
FRONT SIDE REAR FRONT BIDE REAR
2 5' 15` Sof 0
L Al. LOT ARIANCE OR DITIONAL UBE
III
ADDRESS
Y'•e ND MIT NUM
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PLA=G DEP AYP A
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C
CITY
TELEPHONE NUMBER
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STREET
EXISTSDENTCIENCY THIS PROPERTY
XISTINGG STREET R/
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COMP PLAN ST. R FT.
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REMARKS Driveway slopes not to exceed those
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ADDRhSe
indicated on Standard DWC. No.
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CO CXED
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TELEPHONE NUMBE�R/
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METFI E BER�CE SIZE CI.�A CE
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S �T LICEN86 NUMSER
CITY LICENSE NUMBER
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N/WYLi''�Yl_
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-REMARKS
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Legal Dtecrlpllpn at Perty (Show BClow or Atl¢Ch Four Copies)
73
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YPE CONNECTION
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PERO, T
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FIRE TYPE 111 CC lON STREET IMPROVED
I I [ NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
EJ RESIDENTIAL
GAS
LINE
0 YES
PLA CHECKED HY THIS
SIT IS LOCATED IN THE CITY
NEW
NON• RESIDENTIAL
�F EDMONDS. LOCAL SALES TAX
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ADDElRE
slax
RETAINING
H UL BEC DED 31.04.
DININGDEMOLISH
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1 J• I I�/L LrNJ �.�/ L/G/�G� !L'�/ ��
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ALTER
ElFENCE
OR FILL (.......... x .......... Ft.)
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1
PRE -MOVE BwIM
REPAIR ElINSP. O POOL
—NUMBER
_SLJ,es �[�(j/ ��L L� S.�' /.(/�i Gi %C,✓s
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I{
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OF STORIES NUMBER OF
DWELLING
Ii
UNITS
NATURE OF W4KT'Oo B DO0N/E
Vnlu¢tlan
Fee Reee(Pl No.
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I I
Plan Check No.
BUILDING
LQ
1Cy
L
y a
PROPOSED USE
PLUMBING
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PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT A GAS LINE
9
�ja LI ty
FENCE
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SIGN
tRETAINING
WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
1 hereby acknowledge that I bale read tale application; that We In-
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formation given Is correct; and that I nm the owner, or the duly author.
Iced agent of the owner. I agree to comply with City and elate laws regu-
ATTENTION
APPLICATION APPROVAL
-
Iating Construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
TIUS PERMIT
This application is not a permit until
!
relating to Workmen's Compensation Iasurance.
AUTHORIZER
Signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac
-
,hall be c mpleted In ninety days; MOVED -IN BUILDINGS shall be Com-
knowledged in space provided.
pitted 1 z menthe.)
SIGNA tE (ONNER ORA T
DATE S1aNED
INSPECTION
1R R'S O ATURE
/
DEPARTMENT
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-
CITY OF
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•
EDMONDS
ATE ll
LLL/JJJ
NOTE: p aut Subject to Plan Check Fee
775-2525
This Permit covers work to be done on private properly ONLY.
Any const ruction an the public domain (curbs, sidewalks, driveways,
FILE
,.Ill req ulrr nvpn rolr nrrmin•lon.
-4
E 3 of W 330' of N99' of N.W. 4 of N.W. 4
of Sec. 25 Twp 27, Rng 3 EWM Records of Snohomish
County, Washington E 122 is divided I� j
into two pieces: Lots B & C, size
61' X 99' as recorded with City of Edmonds Appr. 515 Holly Drive
PIP-nning-Dept;... File //. S-20-72 Lot !/ C � /�