760163.pdfe
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USE PERMIT 760163
BUILDING DEPARTMENT Applicant Fill ZONE NUMBER
PERMIT APPLICATION Inside Heavy LinesJOB
NAME (OR NAME OF BUSINESS) ADDRESS 20 / / V �J
LEGAL LOT �J LOT IJEA V SUBDIVISION NO,
W , ✓ i/ -�J L SSG/ /,7��(f El YES El N O
W MAILING ADDRESS �
Z VARIANCE OR ADS NO.
0 /�( �J�'j COND, USE NO,
CITY TELEPHONE NUMBER
JJ� PROPOSED YARDS HEIGHT
NAME �•�J FRONT SIDE REAR
F„ ALLOWABLE PROPOSED
U SIGN AREA SIGN AREA
F ADDRESS
= OTHER
U REQUIREMENTS
E CITY TELEPHONE NUMBER
a PLANNING DEPT. APPROVAL DATE
NAME STREET R/W
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/�C,(� iG.��i EXISTING STREET R/W FT, DEFICIENCY THIS PROPERTY
O ADDRESS -
COMP. PLAN ST, R/W FT, FT,
cc 45 E CITY TELEPHONE NUMBER REMARKS
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U STATE LICENSE NUMBER CITY LICENSE NUMBER CHECKED BY
Legal Description of Property (Show Below or Attach Four Copies) STREET AND/OR UTILITY ❑ YES
WORK REO'D ❑ NO
UNDERGROUND ❑ YES
Z WIRING REO'D ❑ NO
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F TYPE CONNECTION VERIFIED BY
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W SEPTIC SYSTEM ElYES PERMIT NUMBER
0 APPVD BY CITY ENG, ❑ NO
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a REMARKS
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METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
REMARKS
RES DENTIAL ❑ GAS
LINE FIRE ZONE TYPE OF CONSTRUCTION CODE
NON-RESIDENTIAL ❑ SIGN
ADD ❑ DEMOLISH QWALL SPECIAL REQUIRED INSPECTOR JAREA GROUP OCCUPANCY OOCACDUPANI
RETAINING
❑ ALTER ❑ EXCAVATE FENCE ❑ YES ❑ NO
OR FILL ( X_FT) PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
PRE -MOVE swim OF EDMONDS, LOCAL SALES TAX
REPAIR INSP, a POOL SHOULD BE CODED 31.04,
REMARKS
.' NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
PROPOSED USE VALUATION FEE
Z PLAN CHECK
0 NO,
y PLOT PLAN INDICATE BUILDING SETBACKS,
ABUTTING STREETS) BUILDING
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of
W PLUMBING
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O HEAT at GAS LINE
FENCE
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SIGN
RETAINING WALL
SWIMMING POOL Nag
I hereby acknowledge that I have read this application; that the In. TOTAL AMOUNT DUE
formation given In correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and statwlaws regu-
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which ONLY THE
shall be com Ieled In nety days; MOVED -IN BUILDINGS shall be com- WORK NOTED
pleted In a onlhs.
(GNAT E (OWN OR AGENT) DA -SIGNED INSPECTION
DEPARTMENT
% CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
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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 space provided.
DIRECTOR'S SI[NATUREJ _ _.'.yet
DATE
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission,
f� ORIGINAYELLOW 'Inspector
PINK - Owner GOLD - Asst'vl r