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EXCAVATION OR FILL
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TOTAL AMOUNT DUE
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ATTENTION
APPLICATION APPROVAL
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METER SIZE j SERVICE SIZE CLEARANCE
Washingtonwill be employed 1, vlolntlop of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
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relntmg to Workmen's Compensation Insurance.
J STATE LICENSE NUMBER
CITY LICENSE NUMBER
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NOTE: Permit Limit One Year (Except DEMOLITIONS which
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shall be completed In ninety days; MOVED -IN BUILDINGS shall be corn-
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INSPECTION
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NATURE OF WORK TO 13E DONE
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Fee Reeelpt No.
Plan Check No.. ...................
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TOTAL AMOUNT DUE
I herebyacknowledge that I have read thin application; that the In-
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formation given Is correct; and that I nm the owner, or the duty author-
ized agent of the owner. I agree to comply with city and elate laws regu.
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorised thereby, no person
Washingtonwill be employed 1, vlolntlop of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
relntmg to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TIIE
WORK NOTED
uty; and fees are paid, and receipt is So.
shall be completed In ninety days; MOVED -IN BUILDINGS shall be corn-
1D3 ledged In Space provided,
pleted in six months.)
Oil AGENT) DATE 816NED
INSPECTION
IRE '8 TORE
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DEPARTMENT
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Ljj0WNEII
9-2G -7
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CITY OF
EDDtONDS
DATE --
NOTE: Applicant Subject to Plan Check Fee
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775-2525
This Perinll coven work to be done on private property ONLY.
Any construction on Ilse public domain (curbs, sidewalks, driveways.
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mnrpurrs, etc.) -111 require separate permleelon.
NEW RESIDENTIAL ❑ LINE
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110-_-EBIDENTIAj ON
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RETAINING
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REPAIR E] PRE -MOVE El SWIM
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U I LDING DEPARTMENT AppU,,ntFlu
heavy Lines
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INSP. POOL
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PERMIT APPLICATION
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NAME (OR NAME OF
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NATURE OF WORK TO BE DONE
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PERMISSIBLE HEIGHT PROPOSED HEI IT
Receipt No.
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REQ RED YARDS PROED YARDS
BUILDING
NAME
FRONT SIDE REAR FRONT 81—DF REAR
PLOT PLAN (Indicate Building sot c batting street.)
HEAT & GAS LINE
ADDRESS
LEGAL LOT - &VARIANCE OR CO�DITIONAL dS`L
PERMIT NUMBER
0 YES [3 NO
PLANNING DEPT.'APPROVAL
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CITY TELEPHONE NUMBER
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SWIMMING POOL
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REMARKSdopes not to (,,Xceel
DEMOLITION
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PRE -MOVE INSPECTION
CHECKED BY
CITY TELEPHONE NUMBER
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TOTAL AMOUNT DUE
METER SIZE BERVI./-, I.. CLEARANCE CHEC BY
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th do he' -
I = a "er, or the
formation given is correct; and that I outo the Owner, or the duty author -
y
".,�CED
STATE LICENSE NUMBER CITY LICENSE NUMBER , "
complyWf' g elate
p b d - laws....
Iced agent of Ills owner. I agree to comply with city arid late laws rtgu-
R,
.L
ATTENTION
APPLICATION APPROVAL
"._an
Riling construction: and In doing the Work authorized thereby, no person
".. -.'it .the - - y 0
REMARKS /-
Ne Labor Code of the State of WuhIngton
will be employed In violation of Lh
TIC18 PERMIT
Legal Description of Property (Show Below or Attach Four Copies)
, blef
Ig
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10
relating to Workmen'. Comp—atl n Itusuream.
AUTHORIZES
signed by the Building Official or his Dep -
70 rY' ell( 440t 71 k
TYPE CONNECTION VERIF ED BY
ONLY TIRE
WORK NOTED
uty; and fees are paid, and receipt is ac -
M ,
.hall be completed In id..ty day.; MOVED -IN BUILDINGS hall be com.
;�i
Imowledged in space provided.
pleted In six months.)
It', rut Ow &Z /A E I?
RC..TES TP!k
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SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
—DIRECTOR -11 SIGNATURE i'.
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L )j
CITY OF
7YI,
DATE
NOTE: Applicant Subject to Plan Cbeck Fce
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
This Permit ro-ra Work to be done on Private property ONLY.
[]'YES [] No
Any r—lr H.. on it.e public domain (.tub., sidewalk., dri-Ir"..
INSPECTOR
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
C] YES O -NO I
NEW RESIDENTIAL ❑ LINE
I,.. CHECKED BY
,,, SITE IS LOCATED IN THE CITY
110-_-EBIDENTIAj ON
061
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OF E LOCAL SALES TAX
RETAINING
/1-(. . .2.
RE ARKBI
11121MIN1261)'D 31.04.
0LL
DEMOLISH WA
ElALT.. E] FENCE ❑PENCE
OR FILL ( X... Ft.)
REPAIR E] PRE -MOVE El SWIM
INSP. POOL
NUMBER OF STORIES NUMER OF
DWELLING
U NITS
F
NATURE OF WORK TO BE DONE
Valuation
Fee
Receipt No.
Plan Check N. ...................
BUILDING
PROPOSED USE
PLUMBING
PLOT PLAN (Indicate Building sot c batting street.)
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
this p I n-
... read is a "C"I"' that I
I hereby acknowledge that I have read this application; that the In-
'
th do he' -
I = a "er, or the
formation given is correct; and that I outo the Owner, or the duty author -
y
complyWf' g elate
p b d - laws....
Iced agent of Ills owner. I agree to comply with city arid late laws rtgu-
R,
.L
ATTENTION
APPLICATION APPROVAL
"._an
Riling construction: and In doing the Work authorized thereby, no person
".. -.'it .the - - y 0
Ne Labor Code of the State of WuhIngton
will be employed In violation of Lh
TIC18 PERMIT
This application Is not a permit until
'
10
relating to Workmen'. Comp—atl n Itusuream.
AUTHORIZES
signed by the Building Official or his Dep -
- l
NOTE: Permit Limit One Year (Except DEMOLITIONH which
ONLY TIRE
WORK NOTED
uty; and fees are paid, and receipt is ac -
M ,
.hall be completed In id..ty day.; MOVED -IN BUILDINGS hall be com.
Imowledged in space provided.
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
—DIRECTOR -11 SIGNATURE i'.
CITY OF
EDMONDS
DATE
NOTE: Applicant Subject to Plan Cbeck Fce
775-2525
This Permit ro-ra Work to be done on Private property ONLY.
Any r—lr H.. on it.e public domain (.tub., sidewalk., dri-Ir"..
INSPECTOR
marque.., etc.) %%III require separate permission.