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1-3190
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HTY TELEPHONE NUMBER
STATE LICENSIINUDIBER CITY LICEN
rZJL
BE NUMBE
Legal Description at Properly (show Below or Altnch Four Copies)
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN 8T. R/W ............FT. ............FT.
REMARKS
N(CHECKED BY
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[i PERC. TESTI PERMIT NUMBER M
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REMARKS
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FIRE ZONSr tTYPE OF CONSTRUCTION STREET IMPROVED
Valuation
Ire.
Receipt No.
SPECIAL INSPECTOR REQUI.
E]GASI
RESIDENTIAL
❑
NE
O"I. DHECK D DY
❑ NEW
❑ ADD
❑ ALTER
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❑
❑
❑
❑
NON-RESIDENTIAL
DEMOLISH I[:]WALL
EXCAVATE
OR FILL
IN PAIOVE
❑
❑
SIGN
RETAINING
FENCE
(......__x .......... Fl.)
POOL
REMARKS
PO
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/N7C)
BUILDING DEPARTMENT
Applicant FILL
USE
ZONE
PERMIT ���
NUMBER
PERMIT APPLICATION
Ineldo Heavy Line"
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ADDRE88 /7 /
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DWELLING
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NAME (OR NAME OF BUSINESS)
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PERMISSIBLE
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tied agent of the owner. I agree to comply with city and elate Iawe Mgu•
ATTENTION
LOT COVERAOEe
LOT COVEAGE
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PERMISSIBLE HEIGHT
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CITY
TELEPHONE NUMBER
ACTUAL LOT AREA (
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Signed by the Building Official Or his Dep-
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3 3 7t,
REQUIRED YARDS
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NAME
FRONT SIDE
REAR FRONT SIDE REAR
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pleled In nix months.)
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STREET R/W—I
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1-3190
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HTY TELEPHONE NUMBER
STATE LICENSIINUDIBER CITY LICEN
rZJL
BE NUMBE
Legal Description at Properly (show Below or Altnch Four Copies)
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN 8T. R/W ............FT. ............FT.
REMARKS
N(CHECKED BY
O
[i PERC. TESTI PERMIT NUMBER M
U W
W
REMARKS
r
FIRE ZONSr tTYPE OF CONSTRUCTION STREET IMPROVED
T
N
I
f .4YEB NO
CCUPANCY GROUP
j--?_
SITE IS LOCATED IN THE CITY
DMONDS, LOCAL SALES TAX
LD BE CODED 31.04.
Pion Check No .....................
Valuation
Ire.
Receipt No.
SPECIAL INSPECTOR REQUI.
E]GASI
RESIDENTIAL
❑
NE
O"I. DHECK D DY
❑ NEW
❑ ADD
❑ ALTER
E]REPAIR
❑
❑
❑
❑
NON-RESIDENTIAL
DEMOLISH I[:]WALL
EXCAVATE
OR FILL
IN PAIOVE
❑
❑
SIGN
RETAINING
FENCE
(......__x .......... Fl.)
POOL
REMARKS
PO
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/N7C)
iUMBER OF STORIES
NUMBER OF
I hereby acknowledge that I have read thin application; that tha /n•
SIGN
30.,x.
DWELLING
I
RETAINING WALL
UNITS
tied agent of the owner. I agree to comply with city and elate Iawe Mgu•
ATTENTION
APPLICATION APPROVAL
VATURE OF WORK TO BE DONE
O/)� gas,-
lating construction; and In doing the work authorized thereby, no person
Will be employed In violation of the Labor Code of the Slate of Washington
THIS PERMIT
T
N
I
f .4YEB NO
CCUPANCY GROUP
j--?_
SITE IS LOCATED IN THE CITY
DMONDS, LOCAL SALES TAX
LD BE CODED 31.04.
Pion Check No .....................
Valuation
Ire.
Receipt No.
BUILDING
PLUMBING
HEAT k GAB LINE
PENCE
I hereby acknowledge that I have read thin application; that tha /n•
SIGN
30.,x.
RETAINING WALL
SWIMMING POOL
tied agent of the owner. I agree to comply with city and elate Iawe Mgu•
ATTENTION
APPLICATION APPROVAL
DEMOLITION
lating construction; and In doing the work authorized thereby, no person
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that tha /n•
/
formation given In correct; and that I em the owner, or the duly author•
tied agent of the owner. I agree to comply with city and elate Iawe Mgu•
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no person
Will be employed In violation of the Labor Code of the Slate of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
Signed by the Building Official Or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac -
l —
shall be completed in ninety days; MOVED -IN BUILDINGS shall be care-
knowledged in space provided.
pleled In nix months.)
RON TURF ( WNER OR AGENT) DATE IGNED
INSPECTION
DIRECTOR•Q _S10N R
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DEPARTMENT
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VJ
CITY OF
I
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
775-2525
This I'emdt a rete work to be don n private property ONLY.
Aar rn nelrnrllnn n lhr pnblle. Jmm�ln (turbo, nldrwalk., drlrewaye,
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