740151.pdfPlan Check No......
BUILDING
I hereby acknowledge that I have read this application; that the In-
PLUMBING
formation given Is correct; and that I am the owner, or the duly author-
nFill
ized agent of the owner. I agree to comply with city and elate laws regu-
FENCE
lalling zaxtructica; and In doing the work authorized thereby, no person
BUILDING DEPARTMENT Applicant FW
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PERMIT %tY V {{'I�11
NUMBER 5 I
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SWIMMING POOL
NOTE: Permit Limit One Year (Except DEMOLITIONS which
PERMIT APPLICATION I Inside Heavy Lines
TOB
PRE -MOVE INSPECTION
pleted I onlhs.)
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DAT BION
ADDRESS
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DEPARTMENT
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NAME (OR NAME OF BUSINESS)
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A(GTUAL
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR d-3107
This Fermlt covers work to be done on private property ONLY.
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LOT C,
IAT COVERAGE
LOT COVERAGE
morquree, etc.) will require separate permission.
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PERM ISBIHLE IXEIOIIT
PROPOSED HEIGHT
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CITY
TELEPHONE NUMBER
ACTUAL LOT AREA
TOTAL BLDG. AREA
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REQUIRED YARDS
PROPOSED YARDS
NAME
FRONT SIDE
REAR FRONT HIDE REAR
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ADDRESS
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LEGAL LOT ROR CONDITIONAL USE
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C].� YES � NO PEERMITMIT NUMBE
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CITY TEL PHONE NUMBER
PLANNING DEPT. APPROVAL DA F+.
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EXISTING STREET R/W ............FT.
DEFICIENCY THIS PROPERTY
NAME
COMP. PLAN 8T. A/W ............FT.
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TELEPHONE NUMBER
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METER BILE SERVICE SIZE
CLEARANCE
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STATE LICENSE NUMBER
ITY LICENSE NUMBER
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REMARKS
Legal Description of Property ( aaw/Je�n
Or Atle,C/6Dlea)
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TYPE CONNECTION
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PERC. TEST
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PERMIT NUMBER
REMARKS
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FIRE (TYPE O NBTRU XON STREET IMPROVED
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0 YES A NO.
8� CIAL INSPECTOR REQUIRED
GROUPGAS
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No
❑PLAN IIP
IOCCUPANCY
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❑RESIDENTIAL
NEW
LINE
CHECK
THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
SIGN
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
ADD RETAINING
DEMOLISH WA
REMARKS
ALTER EXCAVATEFENCx
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IRP. POOL
NUMBER OF STORIESNUMBER OF
DWELLING
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NATURE OF WORK TO BE DONE _ — _ Z�—
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Valuation I
Fee I Receipt No.
Plan Check 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.
BUILDING
I hereby acknowledge that I have read this application; that the In-
PLUMBING
formation given Is correct; and that I am the owner, or the duly author-
HEAT A GAB LINE
ized agent of the owner. I agree to comply with city and elate laws regu-
FENCE
lalling zaxtructica; and In doing the work authorized thereby, no person
SIGN
will be employed In violation at the Labor Code of the Stale of Washlogton
RETAINING WALL
N
SWIMMING POOL
NOTE: Permit Limit One Year (Except DEMOLITIONS which
DEMOLITION
shall be completed In dusty days; MOVED -IN BUILDINGS shall be com-
PRE -MOVE INSPECTION
pleted I onlhs.)
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-
knowledged in space provided.
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 elate laws regu-
ATTENTION
lalling zaxtructica; and In doing the work authorized thereby, no person
will be employed In violation at the Labor Code of the Stale of Washlogton
THIS PERMIT
relating to Workmen's Compeneatlon Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY OTE
WORK NOTED
shall be completed In dusty days; MOVED -IN BUILDINGS shall be com-
pleted I onlhs.)
I107UItE OWNEfff���,,,OR EN )
DAT BION
INSPECTION
'/
/
DEPARTMENT
O[
,
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR d-3107
This Fermlt covers work to be done on private property ONLY.
Any construction on the pubac domain (curbs, sidewalks, driveways,
morquree, 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.