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BUILDING DEPARTMENT Applicant Fill ZONE NUMBER 750498
PERMIT APPLICATION Inside Heavy Lines
ADDR ESSA 3a `
NAME (OR NAME OF BUSINESS) 1/ •K W
n LEGAL LOT LOT AREA SUBDIVISION NO.
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VARIANCE ADS NO.
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CITY ELEPHONENUMBER
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NAME
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REQUIREMENTS
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CITY EPHONE NUMBER
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PLANNING DEPT. APPROVAL DATE
NAME
STREET R/W
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CITY TELEPHONE NUMBERREMARKS
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CHECKED BY
STATE LICENSE NUMBER CITY LICENSE NUMBER
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Legal Description of Property (Show Below or Attach Four Copies) STREET AND/OR UTILITY ❑ YES
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WORK REQ'D ❑ NO
UNDERGROUND ❑ YES
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WIRING REQ'D ❑ NO
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TYPE CONNECTION VERIFIED BY
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❑ VES PERMIT NUMBER
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SEPTIC SYSTEM
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APPVD BY CITY ENG. ❑ NO
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REMARKS
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METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
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REMARKS
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❑ NEW IL1 RESIDENTIAL GAS
LINE FIRE ZONE TYPE OF CONSTRUCTION CODE
NON-RESIDENTIAL ❑SIGN
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® ADD S PECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
RETAINING GROUP LOAD
DEMOLISH O REQUIREDN.
n G-pacE WALL
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ALTER ❑ ORCFILLTE FENCE X—� AN CHECKED BV THIS SITE IS LOCATED IN THE CITU
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❑ PRE -MOVE OF
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REPAIR
INSP. 135POOLSHOULD
REMARKS
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NUMBER OF STORIES NUMBER OF
DWELLING
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UNITS
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NATURE OF WOO�RK TO BEGONE
OVALUATION FEE
PROPOSED USE PLAN CHECK
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6 PLOT PLAN INDICATEBUILDIN S BACKS,
ABUTTING STREP S)V BUILDING
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HEAT & GAS LINE
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FENCE
SIGN
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SWIMMING POOL
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I hereby acknowledge that I have reed this appllcatlon; that the In- TOTAL AMOUNT DUE jm�
formation given Ie correct; and that I sm the owner, or the duly author-
Ized agent of the owner. I agree to comply with ally and elate law. Men' ATTENTION
lating Construction; and in doing the work aulharlred thereby, no parson APPLICATION APPROVAL
will be employed In v101nllon of Ne Labor Code Of the Slate of Wasblagton THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation In.urares. AUTHORIZES
signed by the Building Official or his Dep -
ONLY THE
NOTE: Permit Limit One Year -Except DEMOLITIONS which
utyi fund fees are paid, and receipt is ac -
DINGS .0.K NOTED
shall be Completed In ninety day.; MOVED -IN BUILDINGS ehnll be Co.- knowledged in space pro e
plelcd In el month.)
INSPECTION
SIGNAT (OWNFyR OR E�1T) DATE SIG ED DEPARTMENT DIREC R' SIG AT E
CITY OF
(•tom � ._
ED MONOS
DATE
NOTE: Applicant Su ject to Plan Clfeck Pcc l ��
775-2525
This Permit covers work to be done on private property ONLY.
Any on the public domain (Curbs, sidewalks, driveways, ORIGINAL. File YELLOW - Inspeclor i
construction
marquees, etc.) will require separate permission. PINK - Owner COLD - A -es, r '.
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BUILDINUSE
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ZONE
PERMIT
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Inside Heavy Lines
PERMIT APPLICATION
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NAME (OR NAME OF OU51NE551
ADDRESS
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LEGAL LOT,
LOT AREA SUBDIVISION.NOI '
W MAILING ADDRESS
❑ YES ❑ NO
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VARIANCE OR
COND. USE NO.
ADB NO. I '
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ELEPHONE NUMBER
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CITY
PROPOSED YARDS
HEIGHT 1 1
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FRONT
SIDE REAR
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NAME
ALLOWABLE
SIGN AREA
PROPOSED y
SIGN AREA 1
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OTHER
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REQUIREMENTS
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R CITY TELEPHONE NUMBER
PLANNING DEPT. APPROVAL DATE 1 I
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NAME
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STREET R/W
EXISTING STREET R/W
FT. DEFICIENCY THIS PROPERTY
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COMP. PLAN ST. R/W
FT. FT.
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TELEPHONE NUMBER
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REMARKS
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Legal Description of Property (Show Below or Attach Four Copies)
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STREET ANP/QR UTI Hr � j i / •� ❑,YES W
/ L'•`Q NOJ/
WORK REQ'D
UNDERGROUND
7 .KES
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WIRING REQ'D
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TYPE CONNECTION
VERIFL O a
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El YE PERMIT NUMB W 1
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SEPTIC SYSTEM
APPVD BY CITY ENG.
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❑ NO W I
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REMARKS
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METER SIZE SERVICE SIZE CLEARANCE CHECKED BY j
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REMARKS
❑ NEW 0 RESIDENTIAL GLIAN.
INE
FIRE ZONE TYPE OF CONSTRUCTION CODE
❑ NON-RESIDENTIAL ❑SIGN
RETAINING
AlI
)�,� ❑
SPECIAL INSPECTOR AREA
REQUIRED
GNCY LOCACDUPANT
ROUP
('.. D--OL..WALL
WALL
F' Fri
❑ YES ❑ NO
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ALTER ❑ OR FILL EXCAVATE FENCE
❑ (_ X_FT)
❑
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITU W
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OF EDMONDS. LOCAL SALES TAX
REPAIR ❑PRE•MOVE ❑SWIM
INSP. POOL
SHOO DBE O
Z
REMARKS
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NUMBER OF STORIES NUMBER OF
DWELLING
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j
UNITS
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NATURE OF WORK TO HE DONE
VALUATION FEE
PROPOSED USE
PLAN CHECK
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NO.
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p PLOT PLAN IN OICATE B 1 1r! G SP`TBACKS,['�Ca
BUILDING
5-00"
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ABUTTiN STREE!1'SI,V
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yUl , I-
PLUMBING
W so
m • i'`1 '
HEAT C, GAS LINE
FENCE
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SIGN
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RETAINING WALL
SWIMMING POOL
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I hereby acknowledge that I have rend this application; that the In-
TOTAL AMOUNT DUE
,.,motion given Ie correct; and that I nm the Owner, or the duly author-
I:ed agent .f the owner. I agree to comply with city me elate lows rsgu-
ATTENTION
APPROVAL
lating construction; and to doing the work authorized thereby, no person
APPLICATION
Will be employed In violation oI the Labor Code of the state .f wasbingten
THIS PERMIT
This application is not a permit until '
,elating to Workmen's COmpeneatIOn Inenrence.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit limit One Year (Except DEMOLITIONS which
THE
ONLY THE
uty; and fees are paid, and receipt is ac-
ehnll be completed In bluely days; MOVED-IN BUILDINGS slide be cam-
WORK
knoWledged In apace provided. -
pleled /n six month..)
INSPECTION
SIGNATURE (OWNE•R OR AGENT) DATE SIGNED
DEPARTMENT
DIRECTOR'S SIGNATURE-
CITY OF
I
r ..r.,fta-{""7„\
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee-
775-2525
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This Permit covers work to ba done on pr{vote property ONLY.
on the domain (curbs, sidewalks, driveways,
ORIGINAL •File YELLOW -Inspector
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Any construction public
marquees, etc.) will require separate permission.
PINK - Owner GOLD - Assessor
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