750287.pdfRESIDENTIAL
® NON-RESIDENTIAL
DEMOLISH
❑❑
CTE
r
GAB
LINE
BION
RETAINING
WALL
FENCE
BUILDING DEPARTMENT
Applicant Fill
USE /? PERMIT 75
ZONE ( NUMBER / JU28 /
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PLAN CHECKED IIY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
PERMIT APPLICATION
Inside Heavy Lines
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NAME (OR NAMF. OF BUSINESS)
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PIIT COV1BLE e' LOT CO 9r/
LOT COVERAOEe LOT COVERAGE
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ISSTI K"I L J 7
MAILING
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PERMISSIBLE HEIGHT PROPOSED HEIGHT
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TELEPHONE NUMBER
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ACTUAL LOT AREA TOTAL BLDG. AREA
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BION
REQUIRED YARDS YAADB
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FRONT HIDE REAR FRONT SIDE REAR
Vnluntlon
Fee Receipt No.
NAME
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SWIMMING POOL
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LEGAL LOT VARIANCE OR CONDITIONAL USE
0 YES 0 NO PERMIT NUMBER
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EDbIONDB
DEMOLITION
PLANNING DEPT. APPROVAL DATE:
rC CITY
TELEPHONE NUMBER
STREET R/W
EXISTING STREET R/W ............Fr. DEFICIENCY THIS PROPERTY
Tltla Permit ceyen rtork to be done an Private properly ONLY.
NAME
COMP. PLAN ST. R/W ............FT. ............FT.
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REMARKS
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CHECKED BY
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TELEPHONE NUMBER
METER SIZE
I "EAVIC' SIZE I CLEARANCE
CHECKED BY
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STATE LICENSE NUMBER
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CITY LICENSE N BEH
Legal Description of Property (Show Below or Attach Four Copies)
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REMARKS
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1I�VERIFIED
TYPE CONNECTION
BY
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PERC. TEST
I PERMIT NUMBER
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REMARKS
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FIRE TYPE OF CONSTRUCTION STREET IMPROVED
❑ YES ❑ NO
SPECIAL INSPECTOR REQUIRED I OCCUPANCY GROUP
NEW
ADD
ALTER
RESIDENTIAL
® NON-RESIDENTIAL
DEMOLISH
❑❑
CTE
❑
❑
GAB
LINE
BION
RETAINING
WALL
FENCE
O YES [J NO
BUILDING
PLAN CHECKED IIY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
S, PROPOSED UBE
REPAIR
❑
❑
ORFILL
PRE•DIOVE
1NSP.
❑
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BNI3f;....•...n•)El
POOL
THUS PERMIT
This application is not a permit until
MIST) 11 [/1� r'
ISSTI K"I L J 7
PLOT PLAN (lndlcato BUIRMIng eelbnoka, abutting streets)
NUMBER 01e STORIES I NUMBER OF
DWELLING
NOTE: Permit Limit One Year (Except DIONS which
ONLY TIIE
UNITE
0.11
shall be completed In Inety days; MOVED -1N BUILall be com-
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111
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BION
NAT/URE OF WOR�K/TO DE DON,IE/ % �//
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Plon Cheek No .....................
Vnluntlon
Fee Receipt No.
HETAINING WALL
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TOTAL AMOUNT DUE
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i hereby acknowledge that I have toad this appJnhthat Ula In-
BUILDING
torma"On given iscorrect; and that I am the owner,duly author-
S, PROPOSED UBE
ized agent of the owner. I agree to comply with city e laws reg"-
toting
ATTENTION
APPLICATION APPROVAL
PLUMBING
THUS PERMIT
This application is not a permit until
'
PLOT PLAN (lndlcato BUIRMIng eelbnoka, abutting streets)
HEAT & GAB LINE
NOTE: Permit Limit One Year (Except DIONS which
ONLY TIIE
FENCE
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shall be completed In Inety days; MOVED -1N BUILall be com-
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Plcicd In slzn nthdIC�'rUfONEq
BION
INSPECTION
DIRECTOR'S 810
HETAINING WALL
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DEPARTMENT
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SWIMMING POOL
CITY OF
NOTE: Applicant Subject to Plan Check Fee
EDbIONDB
DEMOLITION
PRE -MOVE INSPECTION
Tltla Permit ceyen rtork to be done an Private properly ONLY.
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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i hereby acknowledge that I have toad this appJnhthat Ula In-
1 r
1
torma"On given iscorrect; and that I am the owner,duly author-
ized agent of the owner. I agree to comply with city e laws reg"-
toting
ATTENTION
APPLICATION APPROVAL
construction; and In doing the work authorized, no person
,711 0o employed In vlolatlen of the Labor Code of the Washington
THUS PERMIT
This application is not a permit until
relallpg to Workmen's Compensation Insuranu.AUTHORIZES
NOTE: Permit Limit One Year (Except DIONS which
ONLY TIIE
signed by the Building Official or his Dep -
Ut and fees are Hid, and receipt is ac -
y, P p
0.11
shall be completed In Inety days; MOVED -1N BUILall be com-
NOTED
knowledged in apace provided.
Plcicd In slzn nthdIC�'rUfONEq
INSPECTION
DIRECTOR'S 810
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DEPARTMENT
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CITY OF
NOTE: Applicant Subject to Plan Check Fee
EDbIONDB
DATE -,7�
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775-2525
Tltla Permit ceyen rtork to be done an Private properly ONLY.
Any eonstrnetlen on the public d"" I" (rnrbe, eldewelka, driveway.'
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