740484.pdfB U I LD I N G DEPARTMENT Applicant Flit ZONE NUMB1ER ���"� '
PERMIT APPLICATION Inalde Heavy Lines
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ADDRESS
Plain Check N. .....................
STREET V
PERMI881BLE m
LOT COVERAGEa
SJ IBTI STREET R/W ..........
ACTUAL /
LOT COVERAGE
Bi864YSlEtO�i 0
, A
............FT.
P OPOBj�D HE T
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ACTUAL LOT AREA
ACTUAL LOT
TOTAL BLDG. AREA
REQUIRED YARDS
FRONT SIDE REAR
PROPOSED YARDS
FRONT 91DE REAR
(CHECKED BY
O YES
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AEGAL OTVARIANCE
n NA
OR CONDITIONALUSE +
PERMIT NUMBER A _ v. w./
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Plain Check N. .....................
STREET V
SJ IBTI STREET R/W ..........
_FT. EFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT.
............FT.
REMARKS
SPECIAL INSPECTOR REQUIRED OCCUPANCY
(CHECKED BY
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Plain Check N. .....................
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SPECIAL INSPECTOR REQUIRED OCCUPANCY
❑❑ OAS
RESIDENTIAL LINE
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❑ NEW
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y PROPOSED USE
PLAN CHECKS
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�_ \ THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIALFUI
PLUMRIN6
SIGN
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OF EDMONDS. LOCAL SALES TAX
CODED 31.04.
❑ ADD
❑
DEMOLISH
WALL
SHOULD 8E
REMARKS
❑ ALTER
❑
O OFII.AI.TE
❑
FEN
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❑ REPAIR
❑
PRE -MOVE INSP.❑
..Y..........Ft.7
SWIM
POOL
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LUMBER OF BTORlE9
NUMBER OF
DWELL NO
�••�u/--1/JV �j c�/C
e. L W + 6- 2_
BION
UNITS
RETAINING WALL
IATURE OF WORK TO BE DONE
N
Valuation
Fee Receipt f
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Plain Check N. .....................
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BUILDING
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y PROPOSED USE
'tq
PLUMRIN6
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PLOT PLAN (Indicate Building eetbaclut, abutting .tracts)
HEAT A GAS LINE
S
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FENCE
BION
2� O
3,9
RETAINING WALL
N
SWIMMING POOL
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DEMOLITION
1
PRE -MOVE INSPECTION
EXCAVATION OR FILL
�OI
TOTAL AMOUNT DUE
hereby ackoawledgs that I haus read this apDllcatlob; that the In.
ddd D
ImmuUmt given 1. correct; and that I son the owner, or the duly author-
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Iscd agent of the owner. I agree to comply with city Gad slate Laws reN•
ATTENTION
APPLICATION APPROVAL
letlbg comdrootion: and In doing the work authorised thereby, uo person
I
will be employed In vlolatlob of the LaborCode of the State of Weshl.ston
THIS PERMIT
This application is not a permit until
-
relating to Workmen's Compensation ImurabCa.
AUTHORIZES
by the Building Official or his Dep-
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NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY TILEsigned
WORK NOTED
utyi and fees are paid, and receipt is ac-
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.hall be completed In bluely days; MOVEDdN ]BUILDINGS shall be cum•
knowledged in space provided.
plated In sat months.)
Bl A RE (OWNER OR AO N
DATE SIGNED
INSPECTION
DIRECTOR' lON
DEPARTMENT
7
CITY OF
EDMONDS
DATE
NOTE: _4p ficdnt Subject to Ffdn Check Fee
PR d-I30T
This Permit coven work to be done on private property ONLY.
Any construction an the Public dome[. (curb., sld.walk., drive.".,
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