760377.pdfi
BUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR
NAME
OFj
BUSINESS)
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Applicant fs
Inside Heavy
ESS /3a
LOT LOT A
62YES ❑ NO
NCE OR
USE NO,
'HONE NUMBSED YARDS
FRONT SIDE
ABLE
REAIREMENTS
LEPHONE NUMB
or
EXISTING STREET R/W
COMP, PLAN ST, R/W
REMARKS
MBER 760377
6377
SUBDIVISION *
U ADB NO,
REAR
lem
DATE
FT, DEFICIENCY THIS PROPERTY
FT, FT,
CHECKED BY
STREET AND/OR UTILITY
WORK REQ'D ❑ NO
UNDERGROUND ❑ YES
WIRING REQ'D ❑ NO
TYPE CONNECTION VERIFIED BY
❑ YES PERMIT NUMBER
❑ NO
SEPTIC SYSTEM
APPVD BY CITY ENG,
REMARKS
METER SIZE ISERVICE SIZE
RESIDENTIALGAS
LINE FIRE ZONE TY
IE] NON-RESIDENTIAL ❑ SIGN
DEMOLISH ❑ RETAINING SPECIAL INSPECT(
WALL REQUIRED
❑ ORFILL❑( X FT) PLANE CHECKED ❑ NO
B
PRE -MOVE SWIM
INSP, ❑ POOL
REMARKS
'IES NUMBER OF
DWELLING
UNITS
t TO BE DONE
NG STR
I hereby acknowledge that I have read this application; that the in-
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 state laws regu-
lating construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to WorkmeaY Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
:hall be completed In ninety days; MOVED -IN DUILDINOS shall be com-
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
0/1 oe
NOTE: Applicant Subfeet to Plan 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,
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
❑ YES
ANCE
r]
OF EDMONDS. LOCAL SALES TAX
VALUATION
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FEE
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\L AMOUNT DUE
ATTENTION APPLICATION APPROVAL
THIS PERMIT
AUTHORIZES This application is not a permit until
ONLY THE signed by the Building Official or his Dep-
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
DEPARTMENT DIR OR•S SIGTIAT UR EI - - - •�
CITY OF tF `l}?; r� i,�: ! •. .
EDMONDS+1.
DATE
775-2525 "
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FINAL