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BUILDING DEPARTMENT I Applicant 1`111 NUMBER 750284
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PERMIT APPLICATION Inside Heavy Lhles JOB /��—
ADDRESS 'C � ��(.
I NA/1ME OR NAME OF NESE) pgT;aIIH�IDL)in J ACTUYYYAL /
w HUS �i . z. LOT COVERAOE
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£81
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LEGAI, LOT vA,u nrve:r. �.. w........,.. •._ ___
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ADDRESS
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Pion Check N. .....................
0 YES NO PERMIT NUMDER
PLANNING )EPT. APPROVAL DATE:
-,
TELEPHONE NUMDER
BUILDING
CITY
I PERMIT NUMBER
STREET
DEFICIENCY THIS PROPERTY
PLUMBING
EXiBTING STREET R/tV ............FT.
NAME
COMP. PLAN 8T. R/W ............Fr. ............FT.
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PLOT PLAN (Indicate Hulmmg eatbaCke, abutting streets)
KEMARIfS Driveway slopes not to exceed those
FADDItEBB�
indicated on Standard Dwa No. 103
O
[]YES E)NO
CHECKED BY
C11'Y
TELEPHONE NUMBER
I
L
I
METER SIZE SERVICE SIZE CLEARANCE CHECKED DY
V-_ —^ •-_^`•^^ ...,.,..�..
r�ITY LICENSE NUMDER
I I I
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W
A
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Pion Check N. .....................
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7
BUILDING
PERC. TEST
REMARKS
I PERMIT NUMBER
PROPOSED USE
PLUMBING
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
�
PLOT PLAN (Indicate Hulmmg eatbaCke, abutting streets)
HEAT @ GAS LINE
FENCE
I
[]YES E)NO
RETAINING WALL
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
Vll RESIDENTIAL
❑
OAS
LINE
❑ YES ❑ NO
BY
LOCATED IN THE CITY
❑
NEN
!'•'
PLAN CHECKED
THIS SITE 15
OF EDMONDS. LOCAL SALES TAY,
❑
NON-RESIDENTIAL
❑
BION
TOTAL AMOUNT DUE
"OLDIE CODED 3104.
❑
ADD
rormatlon given le correct: and that I am the owner, or the duly author•
I to comply with City and state laws reg.-
I•IIrNG
RETAINING
RE�ARK9
Ized agent of the owner. agree
Iating construction; and In doing the work authorized thereby, no person
be In violation of the Labor Code of the Stale of Washington
ATTENTION
TINS PERMIT
This application Is not a permit until
❑
DEMOLISH
AUTHORIZES
signed by the Building Official or his Dep -
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NOTE. Permit limit One Year (Eicept DEMOLITIONS which
❑
ALTER
❑
EXCAVATE
Iy❑1�
r �t
�EAyLL
T.1.vK•.R.aj7....Ft.)
pleted In six menthe.)
SIGNATURE (OWNER R AG£N'r) DATE SIGNED
❑
REPAIR
❑
NSPnIOVE
❑
swim
POOL
.
AT
NUMBER Or STORIES
NUMBER F
-WE-ING
I
UNITS
�/.X/b�.( ��
Pion Check N. .....................
-,
't
7
BUILDING
•.
�V
PROPOSED USE
PLUMBING
PLOT PLAN (Indicate Hulmmg eatbaCke, abutting streets)
HEAT @ GAS LINE
FENCE
SIGN
RETAINING WALL
N
ISWIMMING
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
J�� /�QQ
TOTAL AMOUNT DUE
Ihereby dcknowledge that I have read this application; that the In
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rormatlon given le correct: and that I am the owner, or the duly author•
I to comply with City and state laws reg.-
APPLICATION APPROVAL
Ized agent of the owner. agree
Iating construction; and In doing the work authorized thereby, no person
be In violation of the Labor Code of the Stale of Washington
ATTENTION
TINS PERMIT
This application Is not a permit until
will employed
relating to Workman's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE. Permit limit One Year (Eicept DEMOLITIONS which
ONLY TRE
WORK NOTED
uty; and fees are paid, and receipt is Be
shall be completed In ninety days: MOVED -IN BUILDINGS shall be com-
Imowledged In space provided.
pleted In six menthe.)
SIGNATURE (OWNER R AG£N'r) DATE SIGNED
INSPECTION
Dl TOR'8 SIGNATURE
DEPARTMENT
CITY OF
f
.
AT
ED➢SOND9
NOTE: Applicant Subject to Plait Check Fee 1( _'I, �__,_.._—•-- --
775-2525 td
This Permit a• cork to Iw don n prlyntn properly ONLY.
Any eonetructlunt on Ibe public dontoin (c.rbe. eldewWlle, driveway., FILE .
marquees, els.) will require ep—le permleeisn.