760216.pdfBUILDING DEPARTMENT I Applicant FIR
PERMIT APPLICATION Inside heavy Lines
%NAME (OR
} NAME OF BUSI Ess)
AILING ADDRESS /
CITY TELEPHONE NUMBffiR
NAME
W ADDRESS
F
D
CITY I TELEPHONE NUMBER
or
USEPERMIT
Zo
ZGNE ^ NUMBER
JOB iA
f�U2li�
v � I
ADDRESS
V Q
PERMISSIBLE °
LOT COVERAGE
A UAL °o
L COVERAGE
PERMISSIBLE HEIGHT
PROPOBED HEIGHT
ACTUAL OT AREA
T . BLDG. AREA
REQUIRED YARDS
FRONT SIDE REAR
PROPOSED YARDS
FRONT SIDE REAR
r 02
ma's • i
GAL LOT' VARIANCE OR CONDITIONAL USE
vca r-, ran PERMIT NUMBER
GAS
RESIDENTIAL INE
NEW ❑ NON-RESIDENTIAL
SIGN
ADD ❑. DEMOLISH ❑ RETAINING
WALL
❑ ALTER ❑ ORFILL
EXCAVATE ❑ PENCE ..........Ft.)
❑ REP.IIR PRE -MOVE SWIM
❑ INSP.❑ POOL
IUMBER OF STORIES I NUMBER OF
DWELLING
UNITS
VA'J31lj OF WORY TO BE�Oy)EJ�
Oy
W
PROPOSED U
O
U
aPLOT
PLAN
sc=C
p1 • �� u _. _
'I.A` T EILA1A VAL /�'� r• / J34'rE:
LA\ \STREET R/W
V it (1
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST, R/W ............FT. ............FT.
OF
❑ YES ❑ NO
❑ YES I :
PLAN CHECKS BY THIS SITE IS LOCATED IN THE CITY
19, OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31,04.
RE RKS �O
Valuation Fee Recel
Plan Check No, ....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
hereby acknowledge that I have read thin application; that the in-
on given le correct; and that I am the owner, or the duly author-
, ent o[ the owner. I agree to comply with city and state laws regu-
ATTENTION
construction; and in doles the work authorized thereby, no person
employed 1n violation of the Labor Code of the State of Washington
TlHS I'ER11t1T
to Workmen's Compensation Insurance.
AUTHORIZES
: Permit Limit One Year (Except DEMOLITIONS which
LNOTE:
ONLY THE
WORK NOTED
completed In ninety days; MOVED -IN BUILDINGS shall be com-
In six months.)URE
(OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
% G
CITY OF
EDIIIONDS
NOTE: Applicant Subject to Plat) Check Fee
775-2525
This Permit coven work to be done on private Property ONLY.
Any construction on the public domain (curbs, sidewalks, driven•ars,
marquees, etc.) will require separate permission.
00
13°= 1
a
a
RL6 1
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.
FILE