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PERMIT APPLICATION
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HEAT A GAS LINE
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DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION Olt FILL
TOTAL AMOUNT DUE a 0� 9L)/
I hereby acknowledge that I have road this application; hurt lite III.0
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formntlun nVen b correct; and that I am the owner, ur the duty author-
Ired .seat of the n,a,,. I a.re. to comply with city and .tate laws rem..
ATTENTION APPLICATION APPROVAL
loo..tractlon; and In doing the work authorteed thereby, nn person
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will be employed In Violation of the Labor Code of the Slate of Washington
TITIN PERMIT This application is not a permit until
relating to Workmen'. Compensation Insurance.
AUTHORIZES signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DANS ILITIONN which
lI ILY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
shal) be completed In ninety days, MOl'EB•IN BUILDINGS .hall be Com•
knowledged in space provided.
pleled In .ix month..)
tl1aNATi11if' (OWNER OR AOEIiT) DAT •HON
INSPECTION DIRECTOR' ONA
DEPARTMENT
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CITY OF
EDMONDS DATE [
NOTE! pplicaut Subject to Plan Check Fee
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775.2525
This Permit r cork la be done on Prlvnir property ONLY.
Any construct[ un on the public decant. (curbs, .1dewnik., drir'ewaY.,
FILE
marquee., etc.) will require .ePnrale Oennls.lon.
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NUMBERMOR USE T 7404. ';?
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BUILDING DEPARTMENT Applicant FIRZ014E
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COVER
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LOT COVERAGE
LOT
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MAILING ADDRESS 'I./�
PERJIISSIIILE HEIGHT PROPOSED HEIGHT
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ACTUAL LOT AREA TOTAL BLDG. AREA
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TELEPHONE NUMBER
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Legal Description of Property (snow Below or Attach Four Copies)
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SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
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GAS
❑ LINE
YES NO
❑ NEW
PLAN C}IECKED BY THIS SITE IS LOCATED IN THE CITY
N-RESIDENTIAL
❑ SIGN
OF EDD11NIT LOCAL SALES TAX
sE CODED 31.04.
❑ ADD
RETAINING
REMARKS SHOULD
11 DEMOLISH ❑ WALL
❑ ALTER EXCAVATE FENCE
❑ OR FILL ❑ ..........x..........rt.)
1/ REPAIR ❑ PIRE-2 tOVE ❑ PWINt
NUMBER OF STORIES NUMIIEIt OF
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DWELL ID
NITS
NATURE OF WORK TO BE DONE
Valuation Fee Receipt No.
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Plan Check N.....................
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PROPOSED USE
PLUMBING
PLOT PLAN (Indicate Bulldlu�eot``b¢Cke, abutting mlroele)
HEAT A GAS LINE
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FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE-MOVE INSPECTION
EXCAVATION OR FILL
ABIOUNT DUE
hereby acknowledge that I have read this application; that tho In-
on given is correct; and that I am the owner, or the duly author-
ent of the owner. I agree to comply with city and elate laws regu-
ATTENTION
APPLICATION APPROVAL
construction; and In doing the work authorised thereby, no person
employed In violation of the Labor Cade of the State of Waahington
THIS PERMIT
This application is not a permit until
LTOTAL
to Workman's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
-
: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
uty; and fees are paid, and receipt is ac-
completed In ninety day.; alOVED-IN BUILDINGS shall be cam-
Imowledged in space provided.
In mix months.)UIIE
(OWNER OR AGENT) DATE SIGNED
INSPECTION
DIRECTOR'S SIGNATURE
DEPARTMENT
J •- I -
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CITY OF
__
EDMONDS
DATE
!
NOTE: Applicant Subject to Plots Cbeck Fee
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775-2525
This Permit coven work to be done on private property ONLY.
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Any construction on it,. public domain (curb., sidewalks, drhewaya,
INSPECTOR
marquees, etc.) x'111 require separate permission.
JFoundation
/ Plumbing (Partial) (1/�
(Rough) u
Frame
Furnace & Fuel Lines C—�—,I�
Final