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BUILDING DEPARTMENT
ApplicantFill
PERM
°NE NUMBER
740064
PERMIT APPLICATION IInside
Heavy Linda
JOB
NAME (OR NAME OF BUSINEBB)
ADDRESS
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MAILING ADDRESS
PERM -S -LE / ACTUAL
LOT COYERAOE LOT COVAAGE
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PERMISSIBLE HEIGHT7� PFiOYrONBE�HEIOHT'
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CITY
TELEPJ'H`ONE NUMBER
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Legal Description of Property (Show Below or ARach Four Copies)
REMARKS
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REMARKS
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FIRE ONE I TY E OF CONBTFIIICTION
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I STREET IMPROVED
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SPECIAL INSPECTOR QUIRED (OCCUPANCY
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® NEW RESIDENTIAL LINE
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PLAN CHECKED Y THIS SITE IS LCATED
IN THE CITY
11 ADD NON-RESIDENTIAL SIGN
OF EDMONDS. LOCAL SALES TAX
-
RETAINING
DEMOLISH WALL
_.�5t_L'(1f-, SHOULD RF CA D 104
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11 ALTER EXCAVATE FENCE
❑ ORFILL ❑
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REPAIR M PRE -MOVE
SWIM
(NBP. POOL
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NUMBER OF STORMS NUMBER OF
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/ I DWELLING
UNITS
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NATURE OF WORK TO BE DONE
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Valuation
Fee Receipt No.
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Plnn Check No .....................
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BUILDING
t� J � li'y
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PROPOSED UBE
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PLUMBING
PLOT PLAN (Indlcnte Hulld g eetbacke, abutting elrcete)
p
HEAT & GAS LINE
7 G D
,
FENCE
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BION
TRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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1
I hereby acknowledge that I he's read this application; that the In-
formotlon given Is correct;
TOTAL AMOUNT DUE
and that I am the owner, or the duly author-
(ted agent of tha owner. I agree to
comply with city and elate laws mgu-
Miing
✓
Construction; and In doing the work authorised thereby, no person
will be In
ATTENTION
APPLICATIONAPPROVAL
employed violationof theLabor Code of the Stale of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance,
AUT
AUTnO
This applieatio>j Is not a perralt until
NOTE: Permit Limit One Year (Except
ONLY T/IE
THE
signed b Y theulldifig Official or his Dep -
DEMOLITIONS which
shall
shall be completed In bluely days; MOVED -IN BUILDINGS shall be com.
WORK NOTED
uty; and fee. are p>hid, and receipt is ac-
pletcd In etx Mo. he.)
o 1 ed in spacn� prov! ed.
SIONATUIiI (OWNER OR AGENT)
DATE -SIGNED
INSPECTION
DEPARTMENT
EC HIS SIGN !jE
'DATE
CITY OF
:c
NOTE: AQplicant Subject to Plan Cbech Fee
EDMONDS
This Permit coven work to be done o
PR 8-1107
Any construction on the pablln domain (.-be. ldewalk.,�driveways,
manners, Hr.) will rreulrr, erparulr permleelnn'
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