740096.pdfUILDING DEPARTMENT AppucantFm Zo
PERMIT APPLICATION Inside Heavy Lines ,oB _
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STATE LICENSE NUMBER
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PLANNING DEPT. APPROVAL 141DATE:
u RESIDENTIAL
STREET R/W
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
DEFICIENCY THIS PROPERTY
............FT.
REMARKS
0—
NEW
7�DD Sf
CHECKED BY
METER SIZE.
I SERVICE KSIZE
I C
ARANCE I
CHECKED BY
OF EDMONDS. LOCAL SALES TAX
(MOI D B OD D it Os
744005 y
g77 ISTRUCTION STIIE.I [I YEST 1M❑ NO
SPECTOR REQUIRED IOCCUPANC —GROUP
u RESIDENTIAL
O GAS
LINE
❑ YEB NO
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NEW
PLAN CHECK :
THIS SITE IS LOCATED IN THE CITY
ADD
NON-RESIDENTIAL
SIGN
OF EDMONDS. LOCAL SALES TAX
(MOI D B OD D it Os
RETAINING
El DEMOLISH O WALL
REMARKS
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ALTER EXE FEN
❑ ORCFILL ❑ -E..........PLO
ElREPAIRSWI
❑ INSP. O POOL
NUMBER OF BTORIE9 I DWELF
L NO
UNITS
NATU OF WORK To BE DONE
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Valuation
Fce Recclpl N
Pion Cbeck No .....................
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BUILDING
PROPOSED UBE
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PLUMBING
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PLOT PLAN (Indicate Building setback., abutting Street.)
HEAT e: CAS LINE
FENCE
SIGN
RETAINING WALL
N
8WISIMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
T hereby ack.owled.e that I have read this aDDllcatlon; that ms In.
formation given is correet; and that I athe oaer, or the duly author -
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Iced agent of the owoer. I agree to comply with ally and state law. regu•
tall.. conRructton; and In dol. the work authorised thereby, no person
ATTENTION
APPLICATION APPROVAL
will be ..,Played In Violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workman's Compensation Insurance.
This application Is not a permit until
NOTE: Permit limit One Year DEMOLITIONS
AUTHORIZES
ONLY TILE
signed by the Building Official or his Dep-
(Except which
be completed In ninety day.; MOVE0.IN HOILDINOB
WORK NOTED
uty; and fees are paid, and receipt Is ac-
aball De cam-
plete
plated In .lz month..)
knowled gad in apace provided.
e TURF (OWNER OR AGENT1DATE
HfONED
INSPECTION
DEPARTMENT
D1REC a HIGNATU
_
CITY OF
!
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
This Permit core. work to be done on private Property ONLY.
Pn 6-1107
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Any eonstmetlon on the public domain (curb., eld.vnik., driveway.,
nrn„cr., rlc.) .111 r,qulre •r_.t. 11rr.deela.•
FIL:
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