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20NE NUMBIER 750425
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BUILDING DEPARTMENT Applicant Fill `v
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thereby, no
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laling construction; and m doing the work authorised person
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NAME [OR NAME OF BUSINESS) O/r V l0 �WZ
This application Is not a permit until
Totaling to Workmen's Compensation Insurance.
_LEGAL LOT LOT AREA SUBDIVISION NO.
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TOTAL AMOUNT DUE
a ��
or
formation given Ie correct; and that I am the owner, or the duly author-
I2ed agent of Ina owner. I agree to Comply with city slate lawn roN
thereby, no
ATTENTION
APPLICATION APPROVAL
laling construction; and m doing the work authorised person
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application Is not a permit until
Totaling to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (ExreDt DEMOLETION8 which
ONLY THE
uty; and fees are paid, and receipt is aC-
be campitted to ninety days; MOVED -IN BOMBINGS .hell be corn•
WORK NOTED
itnowledged in apace provided.
pial In six months.)
INSPECTION
SIG ATURE )OWNER
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DATE SIG NqE�
DEPARTMENT
DIRECT SIGNAT RE
CITY OF
EDMONDS
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Non-. Applicant Subject to Plan Check Fee
775-2525
DATE
This Permit covers work to be done on private property ONLY,
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Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
PINK - 0, ner COLD • .�•sess,•r
NAME
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IATURE OF WORK TO BE
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BUILDING DEPARTMENT
Applicant Fill
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NUMBER
PERMIT APPLICATION
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PLANNING DEPT. APPROVAL
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NEW
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LINE
EXISTING STREET R/W FT.
NON-RESIDENTIAL
❑SIGN
❑ ADD
❑ DEMOLISH WALL NTNG
❑ ALTER
❑ ORCFILLTE i ENCS X—PTI
ONLY THE
POOL
REPAIR
INSP. O
IUMBER OF STORIES
NUMBER OF
❑ YES
WORK REO'D ❑ NO
DWELLING
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EDMONDS
V NITS
IATURE OF WORK TO BE
DONE
Any construction On the public domain (curbs, sidewalks, driveways,
marquees, otc.) will require separate permission.
'ROPOSED U:E
PLANNING DEPT. APPROVAL
DATE
tormaUon given Is carred; and that I am, the owner, or the duly author-
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STREET R/W
ATTENTION
EXISTING STREET R/W FT.
DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W FT.
FT.
REMARKS %
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
CHECKED BY
WORK NOTED
pletcd In six months.)
INSPECTION
STREET AND/OR UTILITY
❑ YES
WORK REO'D ❑ NO
CITY OF
Ut�DER``GROUND ❑ YES
EDMONDS
WI R'INC�R ERJ'D ❑ NO
775-2525
SEPTIC
APPV D
TEMARKS %
-IRE ZONE I TYPE OF CONSTRUCTION CODE
IPE CIAL I NSPECTOR AREA ,OCCUPANCY OCCUP/
;SQUIRED GROUP LOAD
YES ❑ NO
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD eE GODED 31.04
REMARKS (�1 1
J
VALUATION FEE
PLAN CHECK _
NO.
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
Ihereby acknowledge that I have read this application; that the In-
TOTAL AMOUNT DUE
tormaUon given Is carred; and that I am, the owner, or the duly author-
Ircd agent of the owner. I agree to comply with city and state Sawa -114-
ATTENTION
1.111.6 construcllo.; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the state of Washington
THIS PERMIT
rel.upg to Workmen's Compensation Insuranes.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
shall be completed In ninety days; MOVED -IN BUILDINGS shall be core.
WORK NOTED
pletcd In six months.)
INSPECTION
IGNATURE (OWNER OR AGENT) DATE SIGNED
DEPARTMENT
-
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
775-2525
This Permit covers work to be done on private property ONLY.
Any construction On the public domain (curbs, sidewalks, driveways,
marquees, otc.) will require separate permission.
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
(RECTO R'� SIGNATURE .._...
ATE
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ORIGINAL - File YELLOW - Inspector
PINK - Osvner COLD - Assessor
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