710120.pdfBUILDING DEPARTMEN
PERMIT APPLICATION
NAME (OlMMAigrlg f'
ADDRESS
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Applicant FM
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Legal Description oe.
O �471
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PERMIT
NUMBER
-9 (`"t'�
❑ YES
EXISTING STREET R ....FT. DEFICIEN/C'Y Is PROPER
TY
MBER Y �}
6� COMP PLAN ST R Q FT v
REMARKS
Driveway slopes not to exceed those indicated
on Standard Drawing #103.
to
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TYPE CONNECTION I
SW
VERIFIED BY
PERC. TEST
I PERMIT NUMIE PH
REMARKS
FDUff I '17XJrjU vt M nu AU
ri YE
/1 •J''/� 7 tL �,7,/ r � B ❑ NO
SPECIAL INSPECTOR 99EQUIRED IOCCUPANOX GROUP
(�•.(, El..0 OAS ❑ YES �NO '
RESIDENTIAL LINE PLAN CHECKED BY
NEW TrI�V)
NON-RESIDENTIAL F-1 SIGN
ADD RETAINING REMARKS
ElDEMOU13H � WAIT'
ALTER ❑ ORPILL
EXCAVATE ❑ PENCE„z.......... Ft.)
REPAIR PRE -swim
❑ INSP. MOVE POOL
NUMBER OF BTURiES NUMBER OF
DWELLING
UNITS
NA�W RK TO TO�DONE Valuation Fee Reeelpt No.
Plan Check No , o� 59lF3
.....................
[Oy BUILDING
PROPOSED USE
PLUMHIN6
Q PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT A OAS LINE
O FENCE
ti
SIGN
RETAINING WALL
N
I SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have rend this application; that the In -
TOTAL AMOUNT DUE
formation given Is correct; and that I am the owner, or the duty author-
ised agent of the owner. I agree to comply with city and slate laws regu- ATTENTION APPLICATION APPROVAL
lating construction; and in doing the work authorised thereby, no person
will be employed In violation of the Labor Code of the Stale of Washington THIS PERMIT This application is not a permit until
relating to Workmen's compensation Insurance. AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
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 com. knowledged in space provided.
Dieted Ins oaths.)
8I(INAT /( nt O ENT) PDATE SIGN V DEPARTMENT
DIRE OTO SION U
OITY OF
EDMONDS DATE
NOTE: Applicant Subject to Plan Check Fee PR e-1107 `Z711
This Permit coven work to be done on private property ONLY.
Any construction on the publle domain (curbs, sidewalks, driveways, FILE
marquees, etc.) will require separate permlsslon.
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