710318.pdfDEPARTMENT
APPLICATION
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NEW
ADD
ALTER
REPAIR
NUMBER OF S'
Applicant Fill
Inside Heavy Line
c
RESIDENTIAL
OAS
LINE
NON-RESIDENTIAL
❑
SIGN
DEMOLISH
RETAINING
WALL
❑EXCAVATE
OR FILL
FENCE
(........ ..x.......... Ft.)
PRE -MOVE
INSP.
swim
POOL
DWELLING
UNITS
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-
Ixed agent of the owner. I agree to comply with city and elate laws regu-
lating construction; and in doing the work authorised thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In slx.monthe.)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) win require separate permission.
1 `d.
'OOTED ON MOLL MAP NO.:
PERMIT I O� I
NUMBER
os wDnO se
�1
IIDEYYARD SETBACK
STREET SETBACK REAR YARD SETBACK
I
!
j
USE ZONE
LOT AREA VACANT SITE
❑ YES ❑ NO
I I
iEIOHT
I BUILDING AREA I VARIANCE NUMBER
t
PLOT PLAN APPROVED
,
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
i
S
COMP. PLAN ST. R/W ............FT. ............FT.
a
CHECKED BY
EAETER SIZE SERVICE SWE CLEARANCE CHECKED BY
I I I
REMARKS
TYPE CONNECTION (VERIFIED BY '
i'
PERC. TEST PERMIT NUMBER a
1 '
I 7
REMARKS
FIRE ZONE OF CONSTRUCTION STREET IMPROVED i
(TYPE
❑ YES ❑ NO
SPECIAL INSPECTOR REQUIRED GROUP
'
(OCCUPANCY
❑ YES ❑ NO t,.
PLAN CHECKED BY THIS SITE IS LOCATED IN I H -
CITY OF EDMOND L S
REMARKS TAX SHOULD BE CODED 31.04.
I
t
l "
Valuation Fee Recelpt No.
Pan Check No ..................... �•' ...
BUILDING i
PLUMHIN6
v
HEAT & GAS LINE
FENCE i
SIGN t
RETAINING WALL
SWIMMING POOL -
i
DEMOLITION i
4
PRE -MOVE INSPECTION -
EXCAVATION OR FILL j
t
t.
TOTAL AMOUNT DUE-
vv V
j
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until'
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
uty; and fees are paid, and receipt is ac-
WURR NOTED Imowledged in space provided. '
,i
INSPECTION DIRE OWS SIGNATU {
DEPARTMENT-
CITY OF
EDMONDS
_ PR 6-1107
O-
TT POSTED ON KROL
BUILDING DEPARTMENT ApplicantFlll
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
NAME (OR NAME OF BUSINESS)
i'q 11 1)k / � / '. c . ,.�. BIDE YARD BETE
O
O1T!
NAM;
T
i
or
'
❑ NEW u RESIDENTIAL � LAS
INE
NON-RESIDENTIAL a .,;BIGN`
❑ ADD DEMOLISH ❑ WALIt O.
❑ ALTER ❑ EXCAVATE ❑ FENCE
OR
(
.......... x.......... . )
❑ REPAIRPRE-swim
El INSP. POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
PERMIT e.
NUMBER 71 U. i 8
YES n NO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
❑ YES ❑ NO
A"
Plan Check No .....................
BUILDING
PROF BED USE
PLUMBING
Q
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT h OAS LINE
E
-�i
-
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
t
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 In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY
WORK NO THE
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
IIONATIYRE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PB 6-1107
This Permit covers work to be done on private Property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
❑ YES ❑ NO
S SITE IS LOCATED IN TH
OF EDMnNnc I OGAI S
SHOULD BE CODED 31.6
Fee Recelpt No.
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-
knowledged in space provided.
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