740420.pdfBUILDING DEPARTMENT DOE PERMIT
Appllcaut Fill zoxE ✓% /, � NUMBER —7 ,g O A 70
PERMIT APPLICATION Inside Heavy Lines A D �(S /'+ ' F
ADDRESS n
NAME (OR NAME OF BUSINESS)i/�`fr s�
LOT aCOVERAGE — _ LOT COVE AGE
NAME FRONT SIDEREAR FR T 9ID REAR
Iry
W ADDRESS LE L LOT VARIANCE OR CONDITIONAL tfbE
M E 0 NO ERMIT NUMBER
NO DE
O P V L AT
C, CITY I
TELEPHONE NUMBER
EXIST STREETR/WL^,.,1:9.1' DEFICIENCY THIS PROPER
N COMP PLAN ST R VW7 tI`£'f S FT
REMARKS slope not eeceed those in-
DrivewaylP t t 5 C
dicated on Standard Dwg. No. 103 w
ADDRESS
HE
BY
G C (TELEPHONE
NUMBER
F 'L4JI
_
METER SIZE I SERVICE SIZE I CLEARANCE I
K�Y
STATE LICENSE NUs ER
CITY LICENSE NUMBER
REMA '8 PV6 `'Vr ,r r
1976
Legal DcacrlpLlon of Property (Show Below or Attach Four Copies)
TYPE CONNECTION
VERI y
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PEHC, TEST
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FIRE TYPE �/ pTRUCTION I eTREB IMP OVOED
SPECIAL INSPEC EVUIJRED OCCUPANCY GROUP
I
CAS
/NEW RESIDENTIAL ❑ LINE
❑ YES d0 x.+I
PLA CREC ED BY THIS SITE IS LOCATED IN THE CITY
OF EDMUNDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
NON-RESIDENTIAL ❑ SIGN
non RETAINING
WALT
RE Rxe
DEMOLISH
EXCAVA E FE NC
cr
10'� ��� Udo 5 3
ALTER ❑
OR FILL.........Ft.)
❑ x.
mall ��7!,)k
fG 51175' LiV ��C tld S
REPAIR
❑ INSP.PRE-❑ POOL
d V ]7t \/j 04 S
NUa[BER OP STORIES NUMBER OF
i' DWELLING
UNITS /
NATURE OF WORK TO HE DONE
Valuation Fee Receipt No,
Plan Check No ..... ...............
/p �/
6
BUILDING
¢, PROPOSED USE
aPLUMDIN6
aPLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE d0
o
FENCE
t
q �
s:ax
J
RETAINING WALL
N
t ff/
SWIMMING POOL
I'Y 1
�SL
DEMOLITION
PRE -MOVE INSPECTION
',
•�
EXCAVATION OR FILL
TOTAL AMOUNT DUE U�
7/
I hereby acknowledge that I have read this application: that the In-
aQ
formation given la correct; and that I am the owner, or the duly author-
Ieed agent of the owner. I agree to comply with city and stateIowa regu-
ATTENTION APPLICATION APPROVAL✓
lating conetructlo¢; and to doing the work authorized thereby, no parson
Will be employed In violation of the Labor Code of the State of Wnshmgton
THIS PERMIT This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZE8 signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILL
WORK NOTED uty; and fees are paid, and receipt is ac -
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
knowledged in apace provided.
pieled In . ,months.)
dl0 (OWNS O AGENT)DATE SIGNED
INSPECTION IR OR' 81 NATU `
DEPARTMENT
CITY OF
EDMONDS DATE
NOTE: Applicant Subject to Plan &eek Fee
775-2525
ork to be done on private pro
Thl! Permit -era wpertY ONLY.
Am, remtntrlinn rat the public Asmnln (ritrbe, sidewalks, drlrawaye,
[il i,r'°, r1 �.1 w111 rrl nl r,nepnrwtr I^rn,I..Ini,.
FILF.
- - - --'- fir- �1— - - -- --
Y �'
NOTICE
TO PPMUTTEE AND/OR OWNER
❑ PARTIAL APPROVAL
❑ VIOLATION
❑ CORRECTIONS REQUIRED
PERMIT 7 / z1->0NUMHER t�yLQ
JOB ADDRESS
NO PERMIT - STOP WORK - REMOVE CONSTRUCTION OR OBTAIN
❑ PERMIT AND MAKE WORI{ COMPLY WITH BUILDING LAWS.
CONSTRUCTION IS NOT IN ACCORDANCE WITH APPROVED PLANE
❑ AND PERMIT - STOP WORK. MAKE EXISTING WORK COMPLY WITH
APPROVED PLANS AND PERMIT OR REMOVE IT. �.
❑ STOP WORK - UNTIL AUTHORIZED TO CONTINUE BY INSPECTOR.
r-MRRECTIONS LISTED BELOW MUST BE MADE BEFORE WORK CAN
tL/APPROVED.
WORK DESCRIBED BELOW HAS BEEN INSPECTED AND IS APPROVED.
El
❑CONTACT INSPECTOR AND ❑
ARRANGE FOR APPOINTMENT. RECALL FOR INSPECTION.
� p%f�'.i/7CG S��U�M/�//1/C/¢i60✓'ri J�lJi1 'Y %d /3`cr���•i/J/�
THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED
WI .................. DAYS OR PENALTIES IMPOSED BY LAW MAY BE
AP F SP CT NS CALL: WO(}QX 775-2525 I -
.. INSPECTION)
DEPARTMENT
IN PEOTOR ' ✓ ❑ MSD70 CITY OF
DATE / EDMONDS
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