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BUILDING DEPARTMENT I Applicant FLU
PERMIT APPLICATION Inside Ifeavy Lines JOB ADDREI
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PERMIT
NUMBER
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STREET
SETBACK
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LOT AREA
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7.1051E
AR YARD SETBACK
,CANT HITS
YES ❑ NO 73
,RIANCE NUMBER p,
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EXISTING STREET R/W�- ....FT. DEFICIENCY THIS PROPERTY
COMP. PLAN HT. R/%V$.9..FT. ..1�/t...'T. G
REMARKS
Driveway slopes not to exceed those
indicated on Standard Drawing 4103
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METER IZE HERV 09
CITY LICENSE NUMBER � ^ ,E SI2E CLEARANCECHECK) BY
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-REMARKS /
or Attach Four Copies) 9 �. C ��0� `/ �1r!-Y �I .r//q �it -2 U
GAS
RESIDENTIAL LINE
I NEWIn ❑
J� NON-RESIDENTIAL BION
ADD Q DEMOLISH WAITNINE
ALTER ❑ OR FILL FENCE
FILL EXCAVATE ❑ - Ft)
El REPAIR ❑ PRE -swim
INSP. O POOL
NUMBER OF STORIES NUMBER OF
DWELLING
LKJ UNITS I
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TYPE�CONNECT.I�ON�
VERIFIED
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PERC. TEST I
PERMIT DkUDER
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REMARKS
FIRE Z0aE., I TYPE ON a"BTRUCFION
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`7STREET IMPROVED
I!' ��YES 0 NO
SPECIAL INSPECTOR REQUIRED
C] YES ` O
I OCCUPANCY_ OROS)P
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THIS SITE IS LOCATED IN THE
PLAN CHECKED By - ~
rITY OF EgNq lalnn l ..
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REMARK9 TAX SHOULD BE CODED 31.04.
Plan Check No .....................
Valuation
Fee
Recelpt No.
BUILDING
PLUMBING /%
HEAT d: CAB LINE
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FENCE
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SIGN
RETAINING WALL
SWIMMING 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 In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
TIDH PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
HGNATUIiE (OWNER OR A N'rl DATE SIGNED
(O
INSPECTION
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DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR s-Iloi
This Permit covers work to be done on privnte property 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-
knowledged in space provided.
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