740630.pdfNAME v
FRONT BIDE REAR FRONT BIDE REAR
eUj ADDRESS
LEGAL LOT VARIANCE OR CONDITIONAL USE
O
YES E3 NO PERMIT NUMBER
PLANN NN 0 DEPT. APPROVAL DATE:
CITY
TELEPHONE NUMBER
t
SPECIAL INSPECTOR REQUIRED IOCCUPANGY GROUP
❑ YES ❑ NO
STREET R/W
®
RESIDENTIAL
NON-RESIDENTIAL
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME
Jpzp
PLAN CHECKED DY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 3104
COMP. PLAN ST. R/W ............FT. ............FT.
❑ ALTER
REMARKS
m ADDRESS
OF
U
(CHECKED BY
N CITY
TELEPHONE NUMBER
G
I
METER SILL. I SERVICE SIZE I CLEARANCE I
CHECKED BY
.......I� . . �. .-.- ....� V
Plan Check No .....................
FIRE ZONE I TYPE OF CONSTRUCTION STREET IMPROVI
" YES [] NO
O
BUILDING
SPECIAL INSPECTOR REQUIRED IOCCUPANGY GROUP
❑ YES ❑ NO
NEW
ADD
®
RESIDENTIAL
NON-RESIDENTIAL
GAB
LINE
SIGN
RETAINING
PLAN CHECKED DY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 3104
REMARKS
❑ ALTER
ElDEMOLISH
WALL
FENC%
REPAIR
❑
❑
OR
�N EPLfOVE
❑
El
.......... Ft.)
SWIM
POOL
UMBER OF STORIES
NUMDER OF
RETAINING WALL
DWELLING
N
UNITS
TATURE GF WORK TO
BE DONE
PRE -MOVE INSPECTION
Valuation
Fee I Rnn.t
.......I� . . �. .-.- ....� V
Plan Check No .....................
O
BUILDING
PROPOSED USE
O
PLUMBING
PLOT PLAN (Intllc¢te BUIW In6 aetb¢eke, abutlln6 atresia)
HEAT & GAS LINE
O
O
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
25.00
I hereby acknowledge that I have read this application; that the in -
TOTAL AMOUNT DUE
25> 00
formation given Is correct; and that I am the owner, or the duly .._-
Ized agent of the owner. I agree to comply with city and state law. regu-
lating coastmotion; and In doing the
ATTENTION
APPLICATION APPROVAL
work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
to
THIS PERMIT
This application is not a permit until
relating Workmen'. Compensation Insurance.
AUTHORIZES
ONLY THE
elgned by the Building Official or Ills Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
uty; and fees are paid, and receipt is ac -
shall be completed In ninety days; MOVED -IN BUILDINGS shall be cam•
knowledged In apace
plated In .Iz months.)
provided.
SIGNATURE (OWNER OR AGENT) DATE B16NED
INSPECTION
DI}tE RIB SIGNATURE
Im erial Mort a e Co. 12-11-74
DEPARTMENT
CITY OF
EDMONDS
DATIW.. ..
NOTE: Applicant Subject to Plan Check Fee
_
This Permit corers work to bo don on private propertyONLY.
773-2525
Any const rnrtl¢n ¢n the ptlbllc Aamaln (en rbcn
, .Arndrh'owayn.
trin'e•., �• "ll,r I¢Irr +rp¢r¢Ir 1..•rnil.nlan,
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