770634.pdfBUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAM (OR NAME OF BUSINESS)
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TELEPHONE NUMBER
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ZONE NUMBER-7-7063 A
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ADDRESS / 7 ✓ 4
LEGAL LOT (J LOT AREA J� SUBDIVISION NO,
❑YES El No
STREET R/W
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
COMP, PLAN ST. R/W FT. FT.
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IONE NUMBER STREET AND/OR U1
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UNDERGROUND
WIRING REQ'D.
TYPE CONNECTION
SANITARY SEWER
NUMBER
APPV'D BY CITY ENG.
REMARKS
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CHECKED BY
❑ YES ❑ NO
❑ YES ❑ NO
❑ YES VERIFIED BY
❑ NO
❑ YES PERMI
❑NO
y SIGN AREA ENV. REVIEW ADB NO,
ALLOWED PROPOSED COMPLETE EXEMPT
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YARDS LOT COVERAGE
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❑ NEW RESIDENTIAL ❑ GAS
LINE FIRE ZONE TYPE OF CONSTR 0ON I CODE HEIGHT
❑ ADD NON-RESIDENTIAL ❑ SIGN f /q/
DEMOLISH ❑ WALLI WING SPECIAL REQUIRED INSPECTOR AREA OCCUPGROUP LOAD
OCCUPANT
❑ ALTER ❑ EXCAVATE FENCE ❑ YES NO
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OR FILL PLAN CHECKED Y THIS SITE IS LOCATED IN THE CITY
PRE -MOVE swim OF EDMONDS. LOCAL SALES TAX
REPAIR ❑ INSP, POOL SHOULD BE CODED 31,04.
NUMBER OF STORIES NUMBER OF
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DWELLING
UNITS
NATUR F WORK TO BE DONE
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PROPOSED USE VALUATION FEE
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SIGN
RETAINING WALL
SWIMMING POOL
I hereby acknowledge that I have read this application; that the in. TOTAL AMOUNT DUE
formation given is correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws 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 This application is not a permit
relating to Workmen's Compensation Insurance. AUTHORIZES until sighed by the Building Official or
NOTE: Permit Limit One Year(Except DEMOLITIONS and FILL ONLY THE his Deputy; and fees are paid, and
PERMITS without conditional use permit, which shall be completed in 90 WORK NOTED receipt is acknowledged in space pro -
days; MOVED -IN BUILDINGS shall be completed in six months.) ' ed.
SIGNATURE ( WNER OR AGENT) DATE SIGNED INSPECTION
DEPARTMENT D E T =SIGN4TURE
CITY OF
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EDMONDS DATE Jy
NOTE: licant Subject to Plan Check Fee 775-2525 � � 164
This Permit coven work to be done on private property ONLY. :6 2
Any construction on the public domain (curbs, sidewalks, driveways, ORIGINAL - File YELLOW - Inspector
marquees, etc.) will require separate permission. GOLD - Assessor PINK - Owner
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