740089.pdfBUILDING DEPARTMENT Appu�DtFmll USE 13/N
PERMIT APPLICATION I1(Dslde Heavy Line- ADDRESS �c
LOT
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ADDRESS
OTAL AMOUNT DUE
LEGAL LOT VARIANCE OR CONDITIONAL USE
PERMIT NUMBER
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(zed agent or the owner. I agree to Comply with City alaw. regu-
L YES❑ NO
lalln6 Construction; and In doing the work authorized, no person
PLANNING DEPT. APPROVAL DATE:
SPECIAL INSPECTOR REQUIRED
TELEPHONE NVM R
R/W
NOTE: Permit limit One Year (Except DEIONS which
JaIGNED
ONLY TIS
WORK NOTED
.hall be completed In nicety days; MOVED -IN RUnMall be wm-
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STREET
EXI8TIN6 STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
DEFICIENCY THIS PROPERTY
............FT.
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IGNED
NAME
REMARKS
❑
GAS LINE
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❑PLANY
QQ
❑NEW
EDMONDS
C
CHECK'A
I CHECKED SY
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Any conetrnetinn on the public domain (curbs, sidewalk., drivew'ars,
hill _rra Wra 12, rrat,z.�undsAon
NON-RESIDENTIAL
❑
NU[�MR
HE
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J
❑ ADD ❑ DEMOLISH
❑
RETAINING
METER 81'LE
I SERVICE BIZE
I CLEARANCE
I CHECKED BY
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
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❑ REPAIR ❑
INSP.
❑
REMARKS
Legal Dsecrlpllon or Properly (-B/now At
Below or taen Fon[ Copies)Cr'
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NUMBER OF STORIES/ NUMBER OF
TYPE CONNECTI--ONI,
VER 1IED BY
LD' /�`Y'
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PERC. TEST
I PERMIT NUMBER
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NATURE/ OF�%WORK �TO� HE DONE �1
F.�/
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REMARKS //!
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Pian Caecit 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-
lmowledged in space provided.
�_3- 7��j
FILE
OTAL AMOUNT DUE
I hereby acknowledge that I have read this application;that the In•
// I _y!
I Q YES I] NO
(zed agent or the owner. I agree to Comply with City alaw. regu-
ATTENTION
lalln6 Construction; and In doing the work authorized, no person
will be employed In vlolatlon of the Inbar Coda of the Washington
SPECIAL INSPECTOR REQUIRED
OCCUPANCY OR UP
NOTE: Permit limit One Year (Except DEIONS which
JaIGNED
ONLY TIS
WORK NOTED
.hall be completed In nicety days; MOVED -IN RUnMall be wm-
YES
F-- Z
I
IGNED
INSPECTION
❑ RESIDENTIAL
❑
GAS LINE
❑PLANY
❑NEW
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
CHECK'A
THIS SITE IS LOCATED IN THE CITY
Any conetrnetinn on the public domain (curbs, sidewalk., drivew'ars,
hill _rra Wra 12, rrat,z.�undsAon
NON-RESIDENTIAL
❑
eiax
01 EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
❑ ADD ❑ DEMOLISH
❑
RETAINING
REMARKS
/rte
ALTER ❑ ORCANAi.TE
❑
FEN Cx..........M.I
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❑ REPAIR ❑
INSP.
❑
POOL
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NUMBER OF STORIES/ NUMBER OF
DWELLING
I
UNITS
NATURE/ OF�%WORK �TO� HE DONE �1
F.�/
Valuation
Fee Receipt No.
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Pian Caecit No.. ...................
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HUILDIN6
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4 PROPOSED USE
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PLUMBING
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aPLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
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�
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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.
�_3- 7��j
FILE
OTAL AMOUNT DUE
I hereby acknowledge that I have read this application;that the In•
formation given 1n correct; and that I Lm the Owner, uly anthor-
(zed agent or the owner. I agree to Comply with City alaw. regu-
ATTENTION
lalln6 Construction; and In doing the work authorized, no person
will be employed In vlolatlon of the Inbar Coda of the Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.AUTHORIZES
NOTE: Permit limit One Year (Except DEIONS which
JaIGNED
ONLY TIS
WORK NOTED
.hall be completed In nicety days; MOVED -IN RUnMall be wm-
pleted to six monlhe.)
SIGNATURE (OWNER OR ADEN )
IGNED
INSPECTION
DEPARTMENT
7
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
eR e•uoT
This Permit coven work to be done on private property ONLY.
Any conetrnetinn on the public domain (curbs, sidewalk., drivew'ars,
hill _rra Wra 12, rrat,z.�undsAon
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.
�_3- 7��j
FILE
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RECORD OF INSPECTIONS
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