740430.pdfPERT
BUILDING DEPARTMENT ZONE NUMB
wppucant Ftv ER
PERMIT APPLICATION Inside freavy Line 7G
ADDRESS
NAM (OR NAME OF BVH11113
�s QQ ! PEItMIS8I8LE )
/T77J /7 SO A LOT COVERAGES I
M MAILING ADDREBB
5'.ZS-19,-1/ -rk
CITY TELEPHONE NUMBER
�@ r tyle ---4--- 778-779 �
NAME
FRONT -- - - -SIDE REAR FI
yUj ADDREHB
O
LEGAL LOT VARIANCE OR CONI
El YES 0 NO PERMIT NUMBER
PLANNING DEPT. APPROVAL
CITY
TELEPHONE NUMBER
STREET R/w
EXISTING STREET R/W ............FT. DEF
COMP. PLAN ST. R/W ............FT.
NAME
REMARKS
W ADDRESS
tO
///
N )�
F CITY
TELEPHONE NUMBER
1,
C
O STATE LICENSE NUMBER
CITY LICENSE NUMBER
METER BILE SERVICE
SIZE
I CLEARANCE
CHECKED BY
Legal Description of Properly (Show Below or Attach Four Copies)
REMARKS
HJr"yr
(y�('
1`IC�V�EtRIFFIEED(
I�
�
O
TYPE CONNECTION
BY
tY •I:
W.'
m
PLRC. TEST
I PERMIT NUMBER
Ct✓y ems/
(.d.
;
REMARKS�
f5
PbT ca true e�j
�
Tb s
j
O
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES 0 NO
.W7
I
SPECIAL INSPECTOR REQUIRED
j] YES NO
(OCCUPANCY GROUP
RESIDENTIALElGAS
NEW LINE
El
PLAN CHECKED DY
THIS SITE 15 LOCATED IN THE CITY
NON-RESIDENTIAL SIGN
OF EDMONDS. LOCAL SALES TAX
SHO LD BE CODED 31 04
ADD
DE3fOLI8H El WAIy NINC
t
REMARKS
EJ ALTER E XCAVATE FENCE
` l�-t
O ND 1� V rL
OR FILL
j
REPAIR ❑ PRE -MOVE El SWIM
INSP. POOL
—STORIES
NV\iBEtt OF NUMBER OF
DWELLING
I
UNITS
NATURE OP -WORK TO HE
Valuation
Fee Receipt No.
Plan Check No .....................
I
O
�y
4 PROPOSED VSE
'
BUILDING
UPLUMBING
PLOT PLAN (Indicate Dulldln6 sctbnCks, abultin6 street.)
HEAT k GAS LINE
!
FENCE
�
SIGN
RETAINING WALL
_
+J,
1
N
1
SWIMMING POOL:-
DEMOLITION"—
OG �
1
PRE -MOVE INSPECTION
I
EXCAVATION OR FILL
1 hereby acknowledge that I have read this application; that the In-
TOTAL AMOUNT DUE
ll
formation given Is correct; sad that I acre the owner, or the duly all
�.
tied agent of the owner. I agree to comply with city and Stale Iowa raga-
Iating construction; and In dolag the work authorized Dlsreby, no p.non
ATTENTION
APPLICATION APPROVAL
will be
relating employed In violation at the Labor Code of the State of Washlaglon
to Workmen's
TS PERMIT
This application is not a until
Compensation Insurance.
AUTHORIZES
permit
_ 1
ONLY THE
signed by the Building Official or his Dep-
I----�"'-`—
NOTE:Permit Limit One Year which
WORK NOTED
uty; and fees are paid, and receipt is ac-
Shall be completed In ninety days; MOVED -IN BUILDINGS shall 6e aom•
-IN Bl DINGS1 hall
knowledged In
I
ix moat
plated In six menthe.)
space provided.
BION URE ( IVNEI a A ENT) DATE SIGNED
INSPECTION
DIRECTp 'e f!O E
�^
7 _
DEPARTMENT
- d
CITY OF
EDDIONDS
DATE
,
NOT AQPJicant Ss ject to Plan Check Fee
Thin 1'e It Sayan work in 6c done an Prlyote properly ONLY.
775.2525
Any rn, a actino nn the pnFllr dnno.ln (rnrbn, �IIrv.nlhe. Irlrn�cnys,
`Y
• � a
t ♦ i ��
t