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BUILDING DEPART M ENT Applicant Fill
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PERMIT APPLICATION ( Inside Heavy Lines
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ADDRESS
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NAME (OR NAME OF BUSINESS)
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NUMBER OF STORIES NUMBER OF
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NATURE OF WORK TO BE DONE (
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PRE -MOVE INSPECTION
EXCAVATION OR FILL
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I hereby acknowledge that I have road this application; that We In-
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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 stale laws rogo.
ATTENTION
APPLICATION APPROVAL
laung conatmetlon: and In doing the work authorized thereby, no person
will be employed In violation of tae Labor Code at the State of Washington
Title PERMIT
This application is not a permit until
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relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
uty; and fees are paid, and receipt is ac -
.hall bo completed In bluely days; MOVED -IN BUILDINGS shall be Com-
knowledged in apace provided.
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pleNd In six months.) I
SICNATUIr (OWNER Olt AGENT), DATE elON1�D
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INSPECTION
DEPARTMENT
DI R' SIGNATOR
CITY OF
NOTE: Applicant SfrLjrc[ 10 Plan Cbcck Fee
EDhiONDB
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775-2525
This Permit n work to c dune on private Property ONLY.
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Any eonellurtloo on fillDublla Jomnln (curbs, eldew'Nks, drhroway..
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marpt,".. et e.) w'lll reeUlrc separate permission.
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Applicant Fin ZONE NUMBER
BUILDING DEPARTMENT
PERMIT APPLICATION
Inside Heavy Lines Ios
ADDRESS / /`� � - I•�'(,�.f An, �� r
NAME (OR NAME OF BUSINESS) f `
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M MAII:ING ADDRhdS O '
PERMISSIBLE HEIGHT ROPOSED HEIGHT 0
O CITY TELEP+H�ONE NUMBI.R ACTUAL LOT AREA TOTAL BLDG. AREA L
r REQUIRED YARDS PROPOSED YARDS
NAME l / FRONT HIDE REAR FRONT 81DE REAR
[.. LEGAL LOT VARIANCE OR CONDITIONAL USE 1
yUj ADDRESS �' 0 YES (:I NO PERMIT NUMBER )
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PLANNING DEPT. APPRO - ! / DATE:
CITY
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STREET R/WG ST I i O
EXISTING STREET R/W ............FT. 111 ICIENCY THIS PROPERTY 1 I
NAME ,COMP.a COMP. PLAN ST. R/W ............FT. ............FT. w
REMARKS '4
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C CITY I TELEPHONE NUMBER _
V METER SIZE I SERVICE 812E I CLEARANCE OH CKED HY
STATE LICENSE NUMBERI CITY LICENSE NUMBER C
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REMARKS (✓ � f
Legal Description of Yr perly (show Below or Attach Four Copies)
„(Y f / D TYPE'CONNECTION VER3FIED BY
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FIRE! ZONE TYPE OF CONSTAlJCTIONBTREET IMPROVED
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f f/ •SP.ECIAL'INdPECTOR REQUIRED OCCUPANCY GROUP
RESIDENTIAL 6A9 YE9 �,NO T
❑ LINE PLAN CHECKED BY THIS SITE 15 LOCATED IN THE CITY
❑ NEN
NON-RESIDENTIAL G ,1' �� /
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EDMONDS. LOCAL SALES TAX ,
❑ ❑ SIGN ) �(,�(.._,/, g:e;/ SHOULD BE CODED 31,04.
❑ ADD❑ RETAINING '-REMARKS
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DEMOLISH WAIT'
ALTER EXCAVATE FENCE / iw� / �i:.f �I�/f !'�'J /—Ni(!'I 1/I,(fF-L.L J!✓� f\(�(�: (/ '
❑ OR PILL ❑ (.......,..x..........Fl.)
❑ REPAIR PRE -MOVE SWIM ( i /., �
❑ INSP. ❑ POOL ! f J,f./L/G /!) .✓ (%� / % ,
NUMBER OF STORIES NUMB 11 OF
DWELLING
UNITS /l/
NATURE OF WORK TO BE DONE (•, 1 Valuation Fee Recclpt NO.
�, J' ! ✓1 n'J - L l — Plan Check No .....................
O l �iiiA1�-(.lR 'L BUILDING
PROPOSED USE f:
(/ PLUMAIN6
� PLOT PLAN (IndlCnla Building setback., abutting e[recle) HEAT A GAS LINE
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FENCE
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SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I hove read this application; that the in-
formation Elven In correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and elate laws regu- ATTENTION APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no person
will beemployed In vlolntlo¢ of Ne Labor Code of the Stale Of Washington THIS PERMIT This application is not a permit until
retail.. to Workmen'. Compensation Insurance, AUTHORIZES signed by the Building Official or his Dep -
ONLY TH
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac
Shall be completed In ninety days; MOVED -IN BUILDINGS Shall be coca- Imi)wledged in space provided.
pieted In six months.) i
SIGNATURE WIVNER OR AGENT)! DATE SIONT INSPECTION DIRECTOR'e,'SIGNATU7)
, / / // DEPARTMENT //
D CITY OF i )DAT 'i/t��.�i{U�!
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NOTE: AhQlicant Subject to Plan Cbcck Fee 775-2525 ) `l 0 r'
This Permit cn1'ere work to bo done on private property ONLY.
Any construction on the Public dom¢In (curb., sidewalks, drireways' INSPECTOR
marquee., etc.) will require .eparale permission,
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