770181.pdf;BUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
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Applicant Fill
Inside Heavy Lines
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NUMBER
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PERMIT 770181
USE ^
ZONE Q Y 1 NUMBER
ADDRESS „t�(,J .lU-►t'�
VARIANCE OR CON D. USE NOtERA
HEIGHT
PROPOSED YARDS \LOT COVERA E
`L i FRONT 1� SIDERSIGN AREA ONMENTAL REVIEW
ALLOWED PROPOSED ❑COMPLETE XEMM
REMARKS I
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IN
OYES ONO I I
STREET R/W
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST, R/W FT. FT.
CHECKED BY
Below or Attach Four Copies) STREET AND/OR UTILITY WORK
R/W PERMIT REQUIRED
REQ'D. ❑YES
❑NO
❑YES No
UNDERGROUND
WIRING REQ'D. ❑YES
No
TYPE CONNECTION
VERIFIED BY
SANITARY SEWER
SEPTIC SYSTEM
EONO
SPERMIT
NUMBER
APPVD BY CITY ENG.
REMARKS
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1�
METER SIZE IsERVICE
SIZE
1CLEARANCE CHECKED BY.
❑ NEW iLl RESIDENTIAL ❑ GAS
LINE
❑ NON-RESIDENTIAL ❑ SIGN
ADD DEMOLISH
RETAINING
WALL
❑ ALTER ❑ EXCAVATE ❑ FENCE
ORFILL X—F )
REPAIR ❑ PRE-MOVE
PMOV E ❑ Pwim
OOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BEDONE
ABUTTING STR
RKS N/A
E ZONE TYPE
NCCIAL INSPECTOR O
aUIRED GRUP
YES 95wN0 1
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS, LOCAL SALES TAX
PLAN CHECK
NO,
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
I hereby acknowledge that I have read this application; that the rTOTAOUNT DUE
formation given is correct; and that I am the owner, or the duly authized agent of the owner. I agree to comply with city and state laws regENTION
lating construction; and in doing the work authorized thereby, no pers
willbe employed in 7iolnion of the Labor Code of the State of WashingtPERMIT
relating to Workme^ i. Compensation Insurance. ORIZES
NOTE: Pe:idit L�RIlt One Ye01'(Except DEMOLITIONS and FILY THE
PERMITS without conditional use permit, which shall be completed in K NOTED
days; MOVED -IN IIUILDINGS shall be completed in six monthECTION
SIGNATURE (OWNER OR AGENT) DATE SIGNEDRTMENT
zC�ilr �TY OF
MONDS
NOTE: Applicant Subject to Plait Check Fee 775-2525
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.
VALUATION I FEE
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17
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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.
DATE
3-23-��
ORIGINAL - File YELLOW - Inspector
GOLD - AsscssN PINK -Owner