750466.pdfl
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BUILDING DEPARTMENT Applicant Fill
ZONE
PERMIT
NUMBER
/50466
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PERMIT APPLICATION Inside Heavy Lines
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ADDRESS
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NAIDR NAME OF BUSINE )
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LEGAL LOT
LOT AREA SUBDIVISION NO,
❑ YES ❑ NO
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VARIANCE OR
ADD NO.
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COND. USE NO.
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TELEPHONE NUMBER
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PROPOSED YARDS
HEIGHT
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FRONT
SIDE REAR
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NAME
ALLOWABLE
PROPOSED
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SIGN AREA
SIGN AREA
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ADDRESS
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OTHER
REQUIREMENTS
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CITY
TELEPHONE NUMBER
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PLANNING DEPT. APPROVAL
DATE
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NAME
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STREET R/W
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EXISTING STREET R/W
FT, DEFICIENCY THIS PROPERTY
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ADDRESS
COMP, PLAN ST. R/W
FT. FT.
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TELEPHONE NUMBER
REMARKS
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
CHECKED BY
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Legal Description of Property (Show Below
or Attach Four Copies)
STREET AND/OR UTILITY
❑ YES
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WORK REO'D
❑ NO
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UNDERGROUND
❑ YES
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WIRING REQ'D
❑ NO
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TYPE CONNECTION
VERIFIED BY
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NC1YES
PERMIT NUMBER
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SEPTIC SyS TEM
APPVO BY CITY ENG.
❑ NO
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REMARKS
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METER SIZE SERVICE SIZE CLEq RA NCE CHECK EO BY
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REMARKS
❑ NEW
El RESIDENTIAL
E I LINE
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FIRE ZONE
TYPE OF CONSTRUCTION
CODE
❑ NON-RESIDENTIAL
❑ SIGN
❑ ADO ❑ DEMOLISH ❑
RETAINING
R..-. RED SPECTOR
AREA
GROUPANCY LOADPANT
WALL
❑ ALTER EXCAVATE FENCE
ORFILL ❑ (� X_FT)
❑ YES ❑ NO
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PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
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PREM OVE SWIM
REPAIR ❑ OpOOL
INSP.
SHOULD BE
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REMARKS
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NUMBER OF STORIES NUMBER OF
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DWELLING
UNITS
12
NATURE WrOjtK TO B NE
/OOF
VALUATION FEE
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PROPOSED USE
PLAN CHECK
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NO.
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PLOT PLAN INDICATE BUILDINGSETBACKS.
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ABUTTING STREETS)
BUILDING
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PLUMBING
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HEAT & GAS LINE
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FENCE
SIGN
RETAINING WALL
SWIMMING POOL
TOTAL AMOUNT DUE
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I hereby acknowledge that I have reed this application; that the In.
formation given Is correct; and that I am the owner, er the duly author
Ized agent of the caner. I agree to comply with city and stab laws reg.-
thereby, no
ATTENTION
APPLICATION APPROVAL
ISUng COnetructiml; and In doing the work authorized person
Will be employed In violation of the Labor Code of the Btate of Washington
THIS PERMIT
This application Is not a permit until
relating to Workmen's Compensation Ineurnem.
AUTHORIZES
Dep-
Signed by the Building Official or his Dep-
NOTE: Permit Limit One Year DEMOLITIONS which
ONLY THE
utyi and fees are paid, and Ieceipt is Be
-111 Bl DINGS
.hall be completed to Nn y 0 MOVED•IN BUILDINGS shell De core.
WORK NOTED
1tnoWledged in apace provided.
plctcd In etc monlhq.
INSPECTION
SIGN U IOW R R A •NT)
GATE SIGNED
DEPARTMENT
OIRpp DTO R'S SIGNAT�IRE
L�
CITY OF.'±.
EDMONDS
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NOT11": Wicant Subject to Plan C7ieck Fee
775-2525This
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Permit covers work to be done on private property ONLY.
domain (curbs, driveways,
ORIGINAL-File YELLOW -Ins actor
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Any construction on the public sidewalks,
marquees, Inc.) will require separate permission.
PINK-0—e, COLD - A'.erssnr
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