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ERLDING DEPARTMENT Applicant Fill ZONEry NUMBER rtl ]Q ]
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ADDRESS
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APPLICATION APPROVAL
P ANNING,DEPT. A ROVAL ❑ATE
NAME JOB NAME OF BUSINESS)
120 - 5th Avenue North
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NEW
uty; and fees are paid, and receipt is ac-
STREET R/W 1
LEGAL LOT
LOT Ar�R.�EA SUBDIVISION
NO,
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ADDRE �
CITY OF EDMONDS
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NON-RESIDENTIAL
CITY TELEPHONE NUMBER
REMARKS
MAILING ADDRESS
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STATE LICENSE NUMBER CITY LICENSE NUMBER
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UMBER OF STORIES
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ATU RE OF WORK TO BE DONE
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ADDRESS
REMARKS
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OTHER
REQUIREMENTS
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APPLICATION APPROVAL
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NAME
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EXISTING STREET R/W Ee CI FT. DEFICIENCY THIS PROPERTY
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250 -5th North
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REMARKS
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Legal Description of Property (Show Below or Attach Four Copies)
STREET AND/OR UTILITyYY ❑ YES
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OCCUPANCY
GROUP
WORK REQ'D NO
UNDERGROUND YES
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Ex GAVATE
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❑ YES NO
Lots I and 2 - Block D
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TYPE CONNECTION VERIFIED BY
City of Edmonds
PRE -MOVE
INSP.
SWIM
O POOL
PLAN c EKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
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UMBER
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SEPTIC SYSTEM
APPVO BY CITY ENG..177
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UMBER OF STORIES
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ABUTTING STR
I hereby acknowledge that I have read this application; that the in-
formation given Is ca rect; and that I am the o or the duly author-
Ixed agent of the owner. I agree to comply with City and slate laws regu-
lating conetruelloa; and to dolog the work euthorired thereby, no person
will be employed In violation of the Labor Code of the State of Wsallington
relating to Workmen's Compensation Insurance.
NOTE: Permit limit One Year (Eicept DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be Com.
pleted In els month..)
SIGNATU�( Jan AGENT) DATE SIGNED
N07F: Applicant Subject to Plat Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
PLAN CHECK
NO.
VALUATION
BUILDING
APPLICATION APPROVAL
PLUMBING
This application Is not a permit until
HEAT h GAS LINE
❑
NEW
uty; and fees are paid, and receipt is ac-
RESIDENTIALAS
LINE
FIRE ZO
TYPE OF ONSr RUC1TION
CODE
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EDMONDS
775-2525
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NON-RESIDENTIAL
❑SIGN
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❑
ADD E]DEMOLISH
RETAINING
❑µTALL
SPECIALINSPECTOR
RED UIRED
AREA
OCCUPANCY
GROUP
OCCUPANT
❑
ALTER ❑
Ex GAVATE
OR FILL
FENCE
(_ x_FT)
❑ YES NO
—
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REPAIR
PRE -MOVE
INSP.
SWIM
O POOL
PLAN c EKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
' SHOULD 8E E
w
D
RLEM ARKS �.1 h h,/7 , I /�� {J f.�
L rl iT-1 Y4 c, Lo(�7 Cf-a151N -rV 11`
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UMBER OF STORIES
IN .ER OF
ING
DWELLING
Pt.ACi✓�D ctrl Q(rLW F u� )A T!G
m
ATU RE OF WORK TO BE DONE
ABUTTING STR
I hereby acknowledge that I have read this application; that the in-
formation given Is ca rect; and that I am the o or the duly author-
Ixed agent of the owner. I agree to comply with City and slate laws regu-
lating conetruelloa; and to dolog the work euthorired thereby, no person
will be employed In violation of the Labor Code of the State of Wsallington
relating to Workmen's Compensation Insurance.
NOTE: Permit limit One Year (Eicept DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be Com.
pleted In els month..)
SIGNATU�( Jan AGENT) DATE SIGNED
N07F: Applicant Subject to Plat Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
PLAN CHECK
NO.
VALUATION
BUILDING
APPLICATION APPROVAL
PLUMBING
This application Is not a permit until
HEAT h GAS LINE
signed by the Building Official or his Dep -
FENCE
uty; and fees are paid, and receipt is ac-
SIGN
knowledged in space provided.
RETAINING WALL
DIRECT R'S 51 'i RE
SWIMMING POOL
/
MEN
%L AMOUNT DUE
I FEC W�(V& D
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application Is not a permit until
AUTHORIZES
ONLY THE
signed by the Building Official or his Dep -
WORK NOTED
uty; and fees are paid, and receipt is ac-
INSPECTION
knowledged in space provided.
DEPARTMENT
DIRECT R'S 51 'i RE
CITY OF
/
EDMONDS
775-2525
DATE
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