710265.pdfPOSTED ON KROLL MAP NO.:
PERMIT
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BUILDING DEPARTMENT
Applicant Fill
1
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PERMIT APPLICATION
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—JOB ADDRESS
NAME
SIDE YARD SETBACK
BTREET SETBACK
REAR
�tYARD
MAILING ADDRESS
USE ZONE
LOT AREA
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VACANT SITE t' I
I TELEPHONE NUMBER
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❑ YEB ❑
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NAME
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PLOT PLAN APPROVED
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pUj ADDRESS
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STREET V
TELEPHONE NUMBER
EXISTING STREET R/W
tq CITY
C
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COMP. PLAN BT. R/Vti
NEW
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LINGASE
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NON-RESIDENTIAL
❑
SIGN
❑ ADD
RETAINING
❑
❑
WALL
El ALTER
❑
DEMOLISH
EXCAVATE
ORFILL
❑
(EN-x.......... Ft.
❑ REPAIR
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PRE -swim
INSPSSOVE
❑
POOL
iUMBER OF BTOR3E8 I NUMBER O
DWELLING
UNITS
VATU/RE OF WORK TO BE DONE '�yy
DEFICIENCY THIS PROPERTY
QFT.
METER IZE SERVI.00E 8 CLEARANCE
CHECKED BY
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REMARKS
TYPE CONNECTION
VERIFIED BY
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PERC. TEST
I PERMIT NUMBER
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IIEMARKS
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FINE TYPE OF CONSTRUCTION STREET IMPROVED
�/- —Al t/ I ❑ YES ❑ NO
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SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
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❑ YES NO 4 r — /
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PLAN CHECKED BY J M I r_v II`t t nc
CITY OF EDMONDS. LOCAL SALE
REMARKS TAX S1100M SE C0UED-3T-0'4_.
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Valuation
Fee
Receipt No.
Plan Check No.
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of
BUILDING
PROPOSED USE
PLUMHIN6
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aPLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT A GAS LINE
11
FENCE
SIGN
RETAINING WALL
N
ISWIMMING
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given Is correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
lating construction; and to doing the work authorized thereby no person
will be employed In violation of the Labor Code of the State of Washington
TIQS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be corn.
pleted In six months.)
31G TURF (G(VNER OR AGENT) DATE SIGNED
IN
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
Pn 6-1107
This Permit covers work to be done on private properly ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
lmowledged in space provided.
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