780147.pdfUSE PERMIT NUMBER 7801647
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BUILDING DEPARTMENT Applicant Fill v p
PERMIT APPLICATION inside Heavy Lines ,OB
ADDRESS I
NAME (OR NAME OF BUSINESS( I LOT AR SUBDIVISION NO.
1 LEGAL LOT
i /� J ❑ YES ❑ NO
MAILING ADDRE55 STREET R/W
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
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ELEPHONE NUMBER COMP PLAN ST• R/W FT,
CITY �
REMARKS
CHECKED BY
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F ADDRESS
= STREET AND/OR UTILITY WORK R/W PERMIT REQUIRED
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BER REQ'D, ❑ YES ❑ NO ❑ y6 ❑ NO
TELEPHONE NUM
a• CITY
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' UNDERGROUND
NAME WIRING REO'D, ❑YES ONO
/9Oy (i O'/t�,0/ Ll �l 670
/0 TYPE CONNECTION OYES VERIFIED BY
E SANITARY SEWER ❑ NO
0 ADDRESS
U �9A;>/;, ❑ YES PERMIT NUMBER
Q L �7 Co S L, SEPTIC SYSTEM
E CITY TELEPHONE NUMBER APPV'D BY CITY ENG, ONO
Z /� S REMARKS , \ t�
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0 l% CITY LICENSE NUMBER N ►I'\
U STATE LICENSE NU BER
h�-O/ / Ale. METER SIZE BUILDING SUPPLY SIZE
Legal Description of Property (Show Below or Attach Four Copies)
REMARKS
ZQ ' N ENV. REVIEW ADB NI
G •�e /L Q4l - SIGN AREA
6 PROPOSED COMPLETE E \
• ALLOWED �1
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7 REMARKS
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G V DATE
W' ' PLANNING REVIEW BY
j VARIANCE OR CU
LOT COVERAGE
YARDS
FRONT SIDE REAR
❑GAS FIRE ZONE TYPE OF CONSTRUCTION CODE HEIGHT NEW ® RESIDENTIAL LINE — - ` `(,�^7 •= .�/•�/
❑ NON-RESIDENTIAL ❑ SIGN N OCCUPANCY / J OCCIU/PA
ADD RETAINING SPECIAL INSPECTOR AREA ( GROUP r LOAD
DEMOLISH ❑ WALL REQUIRED
15 FENCE ❑ YES NO
ALTER ❑ EXCAVATE OR FILL ( X_FT) PLAN CHEC ED By THIS SITE IS LOCATED IN THE T
f17 OF EDMONDS. LOCAL SALES TATAr
PRE -MOVE SWIM Yi"— SHOULD BE CODED 31,04.
❑ REPAIR INSP, ❑POOL
REMARKS IAA �•�^ (� T /� (�
NUMBER OF 5 NUMBER OF-
r(1/� DWELLING ✓ T7
UNITS l _ ^y-
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PLAN CHECK
NO.
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
I hereby acknowledge that 1 have read this appl
ication; that the inly -
formation given is correct; and that I am the owner, tstahe eulaws ized agent of the owner. I agree to comply y and no arson
regu-
lating construction; and in doing the work authorized thereby, p
will be employed in violation of the Labor
Coda of the State of Washington
relating to Workmen's Compensation
InsNOTE: Permit Limit One Year(Except DEMOLITIONS and FILL
PERMITS without conditional use permit, which shall be completed in 90
days; MOVED -IN BUILDINGS shall be completedATE six months.)
OSIGSIGN TUWNER OR AGENT -lox I -
NOTE: Applicant Subject to Plan Check Fee
L AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
775-2525
VALUATION I FEE
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APPLICATION APPROVAL
This application is not a permit
until signed by the Building Official or
his Deputy; and fees are paid, and
receipt is acknowledged in space pro-
vided.
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ORIGINAL - File YELLOW - inspector
(-,OLD . Aaa•ssnr PINK • Owner
This Permit covers work to he done on private property ONLY,
ro co"#.ioq_on the public, duumain (curhs, ^^dm <"k driveways,
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