770715.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICAT"N Inside Heavy Lines
NAME OR NC.ME OF BUSINESS)
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USE PERMIT 7707 15
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ADDRESS / r.^y
LEGAL LOT a / (�I LOT AREA•) jSUBDIVISION NO.
El YES El NO
STREET R/W
EXISTING STREET R/W FT, DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W FT, FT,
REMARKS
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2 CITY ELEPHONE NUMBER STREET AND/OR UTILITY WORK R/W PERMIT REQUIRED
REQ'D. Cl YES ❑ NO ❑ YES ❑ NO
NAME UNDERGROUND
L J� WIRING REDID. ❑ YES ❑ NO
O ADDRESS TYPE CONNECTION ❑YES VERIFIED BY
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C CITY TELEPHONE NUMBER SEPTIC SYSTEM YES
PERMIT NUMBER
F APPV'D BY CITY ENG.
Z ❑NO
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U STATE LICENSE NUMBER CITY LICENSE NUMBER REMARKS
Legal Description of Property (Shaw Below or Attach `F-o�uur Copies) METER SIZE BUILDING SUPPLY SIZE
RE MARKS
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YARDS LOT COVERAGE
/- FRONT SIDE REAR
❑ NEW RESIDENTIAL ❑ GAS
LINE FIRE ZOrrtt��� TYPE OF CONSTRUPTION CODE HEIGHT
❑ NON-RESIDENTIA ❑ SIGN �.
D ADD
19 DEMOLISH ❑WALLRETAINING REQUIRED INSPECTOR SPECIAL AREA CUPAGROUP NCV � OLOCCAUDPANT
❑ ALTER EXCAVATE FENCE ❑ YES
❑
OR FILL _FT)
PLAN CHECK D BY THIS SITE IS LOCATED IN THE CITY
PRE -MOVE swim OF EDMONDS, LOCAL SALES TAX
REPAIR ❑ INSP, EIPOOL SHOULD BE CODED 31,04,
NUMBER OF STORIES NUMBER OF REMARKS ��.+/ +/I7eZ�
DWELLINGN
UITS
NATURE OF WORK TO BE DONE
VALUATION FEE
PROPOSED USE
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S PLOT PLAN INDICATE BUILDING SETBACKS,
is ABUTTING STREETS) BUILDING
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FENCE
SIGN
RETAINING WALL
SWIMMING POOL
I hereby acknowlede that I have read this appliaition; that the in- TOTAL AMOUNT DUE
'ormation given is correct; and that I am the owner. or the duly author -
zed agent of the owner. I agree to comply with city and state laws regu- ATTENTION
ating construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of tW- State of Washington THIS PERMIT
,elating to Workmen's Compensation Insurance. AUTHORIZES
NOTE: Permit Limit One Year(Ercept DEMOLITIONS and PILL ONLY THE
TFUMITS without conditional use permit, which sita'.l be completed in 90 WORK NOTED
lays; MOVED -IN BUILDINGS shall be completed in six months.)
SIGNA RE (OWN OR AGENT) DATE SIGNED INSPECTION
DEPARTMENT
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42
CITY OF
EDMONDS
NOTE: Applicant Subject to Plwt Check Fee 775-2525
This Permit coven work to be done on private property ONLY.
Any construction an the public domain lcurbs, sidewalks, driveways,
marquees, etc,) will require separate permission.
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-
/2-Z--72
ORIGINAL - File YELLOW - Inspector
GOLD - Assessor PINK - Owner
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