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BUILDING DEPARTMENT
Applicant Fill
°NE � NUMBER 750326
LINE
PLAN CHECKEyyD���nDY THIS SITE IS LOCATED IN THE CITY
PERMIT APPLICATION
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NAME (OR NAME OF BUeINESB)
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REMARKS
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REPAIR ❑ IN PMOVE ❑ POOL
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REQUIRED YARDS PROPOSED YARDS
NATURE OF WORK TO BE DONE
NAME
FRONT HIDE REAR FRONT BIDE REAR
Fee
Recoipt No.
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OR CONDITIONAL USE
ADDRESS
LEGAL LOT VARIANCE
0 YE8 0 NO PERMIT NUMBER
Plan Cheek No .....................
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PLANNING DEPT. APPROVAL DATE:
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TELEPHONE NUMBER
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PROPOSED USE
PLUMBING
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STREET R/W
EXISTING STREET R/W ............PT. DEFICIENCY THIS PROPERTY
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REMARKS `
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TYPE CONNECTION VERIFIED BY
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NEW
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LINE
PLAN CHECKEyyD���nDY THIS SITE IS LOCATED IN THE CITY
ON -RESIDENTIAL
staN
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
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ADD
❑ WALL KING
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REMARKS
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DEMOLISH
EXCAVATE FENCE
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NUJ/BER OF BTORI EB NUMBERDWELLING OF
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UNITS
NATURE OF WORK TO BE DONE
Valuation
Fee
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Plan Cheek No .....................
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PROPOSED USE
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HEAT & GAS LINE
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FENCE
BION
RETAINING WALL
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SWIMMING POOL
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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-
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formation given Is correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and Meta Iowa fella.
ATTENTION
APPLICATION APPROVAL
Inting construction; and In doing the work authorized thereby, no person
wit l be ..Played in violation of the Labor Code of the elate of Washington
THIS PERMIT
This application is not a permit until
relnllpg to Workmen's Campenentlon Inaurnnu.
AUTHORIZER
signed by the Building Official or hie Dep -
NOTE: Permit Limit One Year (Except DE51OLITIONS which
ONLY TILE
WORK NOTED
uty, and fees are paid, and receipt Is Be
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shall be completed In ninety days: DIOVF-D•IN BUILDINGS shall be cam•
knowledged in space provided.
pleled Ip eIx month,.)
R OK A NT)
DATE.BIONFrD
INSPECTION
DIRE OR'8 N RE
��jljINATLUREOW
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DEPARTMENT
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CITY OF
EDIKONDS
DATIu
NOTE: Applicant Subject to Plan Check Fee
775-2525-2-16-7)1
T61e Permitraven work to be done on private property ONLY
Any conelruetinn on It,.public domain (curbs, sidewalk,, driveways,
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