750458.pdfBUILDING DEPARTMENT
Applicant Fill
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NUMBER
75r.),
PERMIT APPLICATION
Inside Heavy Lines
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❑
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ORCFILLTE
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ADDRESS
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❑ POOL
NAME (OR NAME OF BUSINESS(
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(UMBER OF STORIES
NUMBER OF
LEGAL LOT
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LOT AREA
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SU DIV ISIOI
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W MAILING ADDRE55
/
0 YES NO
00
3 —
=
OGOND.
VARIANCE OR
USE NO.
Any construction on the public domain (curbs, sidewalks, driveways,
ADB NO.
BUILDING DEPARTMENT
Applicant Fill
ZONE �C _ (O
J
NUMBER
75r.),
PERMIT APPLICATION
Inside Heavy Lines
I
,Da
RETAINING
❑
E]ALTER❑
ORCFILLTE
WALL
X_FT)
F-1 FT
ADDRESS
/9 aje Lrt_
❑ POOL
NAME (OR NAME OF BUSINESS(
Cr /! O Al! �� % I4
!�/L L /•1 it-/
MA�41,
(UMBER OF STORIES
NUMBER OF
LEGAL LOT
❑
LOT AREA
tjo
SU DIV ISIOI
¢�
W MAILING ADDRE55
/
0 YES NO
00
3 —
=
OGOND.
VARIANCE OR
USE NO.
Any construction on the public domain (curbs, sidewalks, driveways,
ADB NO.
CITY
EL EPHONE NUMBER
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STATE LICEN5E NUMBER CITY LICENSE NUMB
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Legal Description of Property (Show Below or Attach Four Cop
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NEW
RESIDENTIAL
LINE
COMP, PLAN ST. Rt,6bl-" V11 FT. t,J FT,
ENTIAL
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Driveway sloe not to exceed those indicated
❑ ADO
❑DEMOLISH
RETAINING
❑
E]ALTER❑
ORCFILLTE
WALL
X_FT)
F-1 FT
REPAIR
❑ INSEFMOVE
❑ POOL
WORK NOTED
Plated In six months.)
(UMBER OF STORIES
NUMBER OF
CITY OF
DWELLING
/
/
;:7-
UNITS
This Permit covers work to be done oIt private property ONLY.
1ATURE OF WORK TO BE DONE
Any construction on the public domain (curbs, sidewalks, driveways,
G ,/�)C,! //li 6
D r�S
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PLOTPLAN JINDICATE BUIL[
ABUTTING STR
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0
EA
OTHER
1REOU REMENTa // V all tl
IM -no -Tc- Vt "
STREET RW
EXISTING STREET RIW3-I/Fv 0FT, DEFICIENCY THIS PROPERTY
COMP, PLAN ST. Rt,6bl-" V11 FT. t,J FT,
REMARKS
Driveway sloe not to exceed those indicated
on Standard Drawing #103.
HEC BY
11 "i"
Will be employed In violation of the Labor Code of the State or Washington
THIS PERMIT
STREET AND/OR UTILITY ❑ YES
WORK REQ'D ❑ NO
UNDERGROUND ❑ YES
WIRING REQ'D E)L710
SEPTIC SYSTEM LJYES [EMIT NUMBeH
APPVO BY CITY ENG. E3 No
�J
YES
PLAN CHECK
NO.
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
I hereby achnpwledge that I have read this appileatIcm; that the In•
TOTAL AMOUNT DUE
formntlan given le correct; and that I em the owner, or the duly author-
I:ed agent or the owner. I agree to comply with city and slate laws ngu-
ATTENTION
Ialln6 conetructlon; and In doing the work authorised thereby, no person
Will be employed In violation of the Labor Code of the State or Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (ExcePt DEMOLITIONS which
ONLY THE
&halt be completed In ninety days: MOVED -IN BUILDINGS shall be com•
WORK NOTED
Plated In six months.)
IGNATURE (OWNFLR OR AGENT) ,t DATE SIGNED
INSPECTtON
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Clleck Fee
775-2525
This Permit covers work to be done oIt private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marqueos, etc.) will require separate permission.
tiyLJ M "�
NSTRUCTION LODE
-db0 /F7-3
t OCCUPAN Y OCCUPAN
GROU )am[ LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS, LOCAL SALES TAX
VALUATION FEE
wo air
POCK
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in apace provided.
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ORIGINAL -_File YELLOW - Inspector
PINK - ,1, COLD - I ,
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