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ADOR ESS
NAME IOR NAME OF BVSINESSI
�1 s TOr1At �„ KEI`I LEGAL LOT
pl MAILING DDR ESS J j'1'�I i1 V El YES ❑ NO
1 VARIANCE OR
3 JGO l dL.YµPiG IfLW RIV�� GOND. USE NO.
O CITY TELEPHONE NUMBER
�^S ` 9-1 PROPOSED VARDS
..--... ✓ `J LJ JJ 77 FRONT
UIREMENTS
EXISTING STREET R/W
COMP, PLAN ST. R/W
or Attach Four Copies) STREET AND/OR UTILITY ❑ YES W
WORK REQ'D ❑ NO
UNDERGROUND ❑YES
WIRING REQ'D ❑ NO �1
TYPE CONNECTION VERIFIED BY
I
❑ YES PERMIT NUMBER W •'
SEPTIC SYSTEM
APPVD BY CITY ENG. ❑ NO W
DT AR V
SUBDIVISION NO.
AOI
NO,
O
RESIDENTIAL
O
Z
I- PLOT PLAN INDICATE BUILDING SETBACKS,
HEIGHT
SIDE REAR
ABUTTING STREETS)
Z (•
Z
J
L NE
PROPOSED
PLUMBING
SIGN AREA
'j
n'
II
NON-RESIDENTIAL
.L DATE
FT. DEFICIENCY THIS PROPERTY
FT. FT.
❑
�j
O WALLI NTNG
REQUI ED SPECIL SPECTf
❑ ALTER
K 1�
W
--
CHECKED BY
RETAINING WALL
Z
ORCFILLTE
�(E X _
D I,I
or Attach Four Copies) STREET AND/OR UTILITY ❑ YES W
WORK REQ'D ❑ NO
UNDERGROUND ❑YES
WIRING REQ'D ❑ NO �1
TYPE CONNECTION VERIFIED BY
I
❑ YES PERMIT NUMBER W •'
SEPTIC SYSTEM
APPVD BY CITY ENG. ❑ NO W
N
I
:E CLEARANCE CHECKED BY
C
W
F
a
3
i
NSTRUCTION CODE j
1 OCCUPANCYOCCUPANT
GROUP LOAD
F
THIS SITE IS LOCATED IN THE CITY w
OF EDMONDS. LOCAL SALES TAX G I
HOULD BE31, 4.
o I
J �I
PROPOSED USE
VALUATION FEE
Z
PLAN CHECK
❑ NEW
O
RESIDENTIAL
OGAS
I- PLOT PLAN INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
BUILDING
L NE
FIRE ZONE TY
PLUMBING
ADD
O
NON-RESIDENTIAL
❑ SIGN
IS
O
HEAT & GAS LINE
❑
OE MOLISH
O WALLI NTNG
REQUI ED SPECIL SPECTf
❑ ALTER
SIGN
--
YES KED
PAN
RETAINING WALL
❑
ORCFILLTE
�(E X _
CHECB
REPAIR
O
tel,
I. hereby acknowledge that I have read this application; that the In-
formallan given 1a correct; and that I am the owner, or the duly Minor-
NSP..
POOL
REMARKS
NUMBER OF STORIES
ATTENTION
APPLICATION APPROVAL
Will be employed In of the Labor Code of the State of Washington
THIS PERMIT
relatlag to Workmen's Compensation Iesuraaes.
This application Is not a permit until
OWE LI GOF
OWE
AUTHORIZES
THE
signed by the Building Official or his Dep -
Shall be completed In nicety days; MOVED -IN BUILDINGS shall be cam-
WORK NOTED
uty) and fees are paid, and receipt is ac-
pleted In atx months.)
UNITS
knowledged In apace provided.
SIG TORE OWN R GENT) DATE SIGNED
1 J)
N
I
:E CLEARANCE CHECKED BY
C
W
F
a
3
i
NSTRUCTION CODE j
1 OCCUPANCYOCCUPANT
GROUP LOAD
F
THIS SITE IS LOCATED IN THE CITY w
OF EDMONDS. LOCAL SALES TAX G I
HOULD BE31, 4.
o I
J �I
PROPOSED USE
VALUATION FEE
Z
PLAN CHECK
'--
O
NO,
I- PLOT PLAN INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
BUILDING
U
Id
PLUMBING
O
IS
O
HEAT & GAS LINE
FENCE
'00 C1
/ a
Q t V
SIGN
--
RETAINING WALL
SWIMMING POOL
TOTAL AMOUNT DUE
tel,
I. hereby acknowledge that I have read this application; that the In-
formallan given 1a correct; and that I am the owner, or the duly Minor-
p(
Ized agent of the owner. I agree to comply with city and stats laws ngu-
and
Iating construction; and In doing the work authorized thenby, no parson
ATTENTION
APPLICATION APPROVAL
Will be employed In of the Labor Code of the State of Washington
THIS PERMIT
relatlag to Workmen's Compensation Iesuraaes.
This application Is not a permit until
NOTE: Permit Limit One Year (Except DEMOLITIONS whichONLY
AUTHORIZES
THE
signed by the Building Official or his Dep -
Shall be completed In nicety days; MOVED -IN BUILDINGS shall be cam-
WORK NOTED
uty) and fees are paid, and receipt is ac-
pleted In atx months.)
knowledged In apace provided.
SIG TORE OWN R GENT) DATE SIGNED
1 J)
INSPECTION
DEPARTMENT
-•
- _
DIRECTOR'S S{�jylGNA
I (/ / �7
?•U J-JI-.L—v !_J �[��//L�
CITY OF
/ryyFj
iL�f'
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
775-2525
DATE 7�
r
This Permit covers work to be done on private property ONLY,
Any construction on the public domain (curbs, sidewalks, driveways,
ORIGINAL - Fdo YELLOW - kspector
margeees, etc.) will require separate permission.
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