750072.pdfTOTAL AMOUNT DUE
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ATTENTION
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SIGNATURE (OWNER OR AGENT) DATE HONED
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TOTAL AMOUNT DUE
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I hereby acknowledge that I have vena this application; that the In-
formation given Is correct; and that I rum the owner, or the duly author.
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(zea agent of the owner. I. agree to comply with city and st.te law. regu-
ATTENTION
APPLICATION APPROVAL
PERC. TEST
PE MIT NUMBER
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REMARKS
This application Is not a permit until
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signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEAIOLIT[ON. which
ONI.Y TItE
WORE NOTED
FIRE ZOTYPE OF CONSTRUCTION STREET IMPROVED
.hallbe completed In ninety days; MOVED -IN BUILDINGS shall be com-
(3YES❑NO
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE HONED
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
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❑ YES 't NO 8_5
❑ ElCA.PLAN
❑ NEN RESIDENTIAL LINE PLAN CHECK D BY THIS SITE 15 LOCATED IN THE CITY
NON-RESIDENTIAL ❑ SIGN OF EDMONDS. LOCAL SALES TAX
"nnD RETAINING REMARKS SHOULD BE CODED 31.04.
DEMOLISH WAS ALL W094C Pt72 ()Pe 197S _
ALTER ❑ OR FALL FEN
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NUMBER OF STORIES NUAIHER OF
775-2525
DWELLING
Tbls Permit Seven work to be done on private property ONLY.
Any eon.lruelimr on the public dom.ln (curb., eWewNk., del_ways,
FILE
marquee., rte.) will require .Spent. permission.
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NATURE OF WORK TO BE DONE
Valuation
Fee
Receipt No.
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DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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I hereby acknowledge that I have vena this application; that the In-
formation given Is correct; and that I rum the owner, or the duly author.
(zea agent of the owner. I. agree to comply with city and st.te law. regu-
ATTENTION
APPLICATION APPROVAL
laiing construction; and In doing the work authorized thereby, no person
will be employed In vlolntla. of the Labor Code or the State of Washington
THIS PERMIT
This application Is not a permit until
relating to Workmen's Compensation IMuraneA.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEAIOLIT[ON. which
ONI.Y TItE
WORE NOTED
Utyi and fees are paid, and receipt is so
.hallbe completed In ninety days; MOVED -IN BUILDINGS shall be com-
knowledged in space provided.
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE HONED
INSPECTION
DIRECTOW8 810 TUJJJiiiE
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DEPARTMENT
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CITY OF
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DAT b
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NOTE: Applicant Subject io Plan Check Fee
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775-2525
Tbls Permit Seven work to be done on private property ONLY.
Any eon.lruelimr on the public dom.ln (curb., eWewNk., del_ways,
FILE
marquee., rte.) will require .Spent. permission.
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DEPARTMENT
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PERMIT APPLICATION I Inside Heavy Lines
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REQUIRED YARDS PRUPONF.D YARDS
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PLAN CHECKED BY THIS SITE IS LOCATED (NITHE CITY
El NON-RESIDENTIAL
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OF EDMONDS. LOCAL SALES TAX
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SHOULD BE CODED 31.04.
REMARKS
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PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
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FENCE
SIGN
RETAINING WALL
-
N
SWIMMING POOL
_
DEMOLITION
PRE-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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I hereby acknowledge that I have read this application; that the In-
tormatlen glue. is correct; and that I am the owner, or the duly author-
I.1d ¢gent of the owner. I agree to comply With City and elate laws regu-
ATTENTION
APPLICATION APPROVAL
luting construction; and In doing the worst authorized thereby, no person
will be employed In Violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation losurance.
AUTHORIZES
Signed by the Budding official or his Dep-
NOTE: Permit Limit One Year (Except 11ESIOLITIONN which
ONLY THE
WORK NOTED
Uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; TSOVED-IN BUILDINGS Shall be nom-
knowledged in space provided.
plated In Six months,)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DIRECTOR'S SIGNATURE
I
DEPARTMENT
CITY OP'
EDAIONDS
DATE - -
NOTE: Applicant Subject to Plats Meek Pee
775-2525
T1ds Pnit ..,a. Work to be done on privets property ONLY.
Any construction on the public domain (enrbs, sidewalks, drlreways,
murpuees, etc.) will requ r. sep¢rale permission.
INSPECTOR
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