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BUILDING DEPARTMENT
Applicant Fill
PERMIT
zoNE Qcj _ `� NUMBER 750373
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PERMIT APPLICATION
Inside Heavy Lines
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ADDRESS 10,12-R4
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CITY
TELEPHONE NUMBER
REMARKS
Driveway slopes not to exceed those
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LICENSE NUMBER
CITY LICENSE UMBE
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Legal Description of Property (Show Below
or Attach Four Copies)
STREET AND/OR UTILI ElYES
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WORK REq'D ❑ NO
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UNDERGROUND MYES
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NEW
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TYPE OF COT1
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❑ NON-RESIDENTIAL
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❑ ADO
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RETAINING
❑ DEMOLISH � WALL
SPECIAL INSPECTOR AREA
REQUIRED
OCCUPANCY OCCUPANT
GROUP LOAD
❑ ALTER Ej .-.AVATE FENCE
OR FILL ❑ I_ x_PTl
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PLAN CH K D aY
THIS SITE
ISL CATED IN THE CITY
❑OF
REPAIR PR.-M.V. SWIM
INSP. O POOL
EDMONDS. LOCAL SALE' TAX
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NATURE OF WORK TO BED
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PROPOSED USE
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VALUATION FEE
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PLOT PLANINDICATE BUILDING SETBACKS,
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BUILDING
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PLUMBING -;17,50
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HEAT &GAS LINE
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FENCE
SIGN
RETAINING WALL
SWIMMING POOL --
TOTAL AMOUNT DUE
I hereby acknowledge the, i have rmd thb eppllcatlon; that the In.
lormnllon given fs correct; and that I am the owner, or the duly author.'
Ized agent of the owner. I agree to comply wfeh city and stale law. else.
latlag 'n.lnlction; and in doing the work authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
will be employed In violation of the Labor Code of the elate of WYhlagton
THIS PERMIT
relating to Workmen's Compensation Insurance,
AUTHORIZES
This application is not a permit unto
.
NOTE: Permit limit One Year (Egcepl DEMOLITIONS which
ONLY THE
signed by the Building Official or his Dep-
a. days; IfOVED-IN BULLDING19 shall be co•
shall he completed In ninetycon
WORK NOTED
uty; and fees are paid, and receipt Is aC-
plated m I. month..)
knowledged In apace provided.
Sl Gt E (OWNER OR AG NTI
SIGNED
INSPECTION
OEPA RTMENT
DIRECT Ofj SIG T RE
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JOATE
7-10-7
CITY OF
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EDMONDS
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NOTE: Applicant Subject to Plan C7leck Fee
775-2525
GATE
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curhs, sidewalks, driveways,
ORIGINAL -File YELLOW • Im,peclor
marquees, etc.) will require separate permission.
PINK - n:-. r COLD - -- .
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