740578.pdfBUILDING DEPARTMENT I Appllt ant F1L ZONE PERMIT
7
PERMIT APPLICATION Ineldo Heavy L1nea JOB
ADDRESS
Id MAILING ADDRESS
CITY
NAME
ADDRESS
CITY
N
of REBS —
cl
z
V__. --.-•--.__ -...-.
LOT
I
-..�......... .....__ _ _-
NT BIDE REAR FRONT HIDE REAR
E]
LINE
LOT VARIANCE OR CONDITIONAL USE
NEW
❑ NO PERMIT NUMBERING
DEPT. APPROVAL DATE:
TELEPHONE' NUMBER
T R/WNG
NON-RESIDENTIAL
E
STREET R/W ............FT. DEFICIENCY THIS PROPERTY
zP.
❑ ADD
PLUMBING
PLAN 8T. R/W ............FT.......FT.KSz
REMARKS
PLOT PLAN (indicate Building setbacks, abutting streets)
❑
DEMOLISH
❑
W=KING
ALTER
�
E
CHECKED BYTELEPHONE
!RETIARKS
SIGN
NUMBER
❑
ORCFILL
SIZE SERVICE SIZE CLEARANCE CHECKED BY
REPAIR
CITY LICENSE NUMBER
N -MOVE
El
SWIM
POOL
7USIBER O1•` eTOfilE3
NUMBER OF
KSW
Below Or AttBth Four Coplea)
CONNECTION VERIFIED BY
TEST
,
PERMIT NUMBER
PRE -MOVE INSPECTION
RK9�
UNITE
EXCAVATION OR FILL
❑ YES [3 NO
DS. LOCAL SALES
RESIDENTIAL
E]
LINE
B
❑PLANCHECKED❑O
Y
NEW
1
BUILDING
❑
NON-RESIDENTIAL
E
BION
❑ ADD
PLUMBING
REMARKS
PLOT PLAN (indicate Building setbacks, abutting streets)
❑
DEMOLISH
❑
W=KING
ALTER
�
E
gNCE
SIGN
❑
ORCFILL
IjT.][....�tl...FL)
REPAIR
❑
N -MOVE
El
SWIM
POOL
7USIBER O1•` eTOfilE3
NUMBER OF
DEMOLITION
DWELLING
I
,
PRE -MOVE INSPECTION
UNITE
EXCAVATION OR FILL
❑ YES [3 NO
DS. LOCAL SALES
Plan Check No. .....................
1
BUILDING
PROPOSED USE
PLUMBING
j
PLOT PLAN (indicate Building setbacks, abutting streets)
HEAT A CAB LINE
FENCE
�
�e 0 D
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
,
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I
TOTAL AMOUNT DUE
I hereby acknowledge that 1 have reed t61e nppllcptlon; that the In-
P -
formation given le correct; and that I am the owner, or the duly author -
tied agent of the owner. I agree to comply with city and .lata law. rsgu-
ATTENTION
APPLICATION APPROVAL
filing construction; and In doing the work authorised thereby, no person
will be employed In violation of the Labor Code of the State of Weahiogton
THIS PERMIT
This application is not a permit until
relating to Workmen'. Compensation Insurance.
AUTHORIZES
Signed by the Building Official or his Dep-
I
II ~
NOTE: Permit Limit One Year (Except DEMOLITIONS which
Y
ONLTnE
WORK NOTED
uty; and fees are paid, and receipt fa Re-
__
r`
.hall be completed In ninety days; 3IOVED-IN BUILDINGS shall be cam-
knowledged in space provided.
pitted In six months.)
ZION RE (Ot ER AO T) / DATE SIGNED
INSPECTION
DEPARTMENT
DI OR'S B�GNAT E
,/`�,(-r0
) r'''` '.i• ��''�
CITY OF
EDMONDS
DATE
NOTZ Applicant Subject to Plan Check Fee
Q
775-2525
This Permit covers work to be dune on private property ONLY.
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Any ron�t roti tars at thr I lllr domaln (rnrba, aldrwal ke, Arivewny"•
FILE
cul c a ale—alaelun. �