760672.pdfUSE PERMIT i DUO
BUILDING DEPARTMENT Applicant Fill ZONE NUMBER
PERMIT APPLICATION inside Heavy Lines \ E
ADDRESS ' / / �� t `i�
NAME OR/�JAME OF BUSINESS) ESS�
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NAME
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Q LANNrGIEP , A10 PPROVAL ; 1 DATE
NAME '
STREET R/W
EXISTING STREET R/W(00/&0 FT, DEFICIENCY THIS PROPERTY
0 ADDRESS-
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of /K�_ + REMARKS
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WORK REQ'D
UNDERGROUND YES
Z WIRING REQ'D ❑ NO
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W SEPTIC SYSTEM NA,
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REMARKS
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Itll NEW RESIDENTIAL LINE FIR
ill ❑ NON-RESIDENTIAL ❑ SIGN
❑ ADD ❑ DEMOLISH ❑WALL REQUIREI
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❑ ALTER ❑ ORCFILLTE ❑ FENCE X—YES
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REMARK:
NUMBER STORIES NUMBER OF _
DWELLING
UNITS JL
NATURE OF WORK T(7)BE DOME
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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 or 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 or Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted
GNATUR ( NER O AGENT) DATE SIGNED
7
NOTE: Applicant Jett to Plan Check Fee
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IQL NO I I'
KED BY THIS SITE IS L CATED N THE CITY W
OF EDMONDS. LOCAL SALES TAX 0
SHOULD BE CODEDZ
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VALUATION FEE
PLAN CHECK NO, 344OO
BUILDING / E O O
PLUMBING /" 26 11 60
HEAT & GAS LINE yE QO
FENCE U
SIGN
RETAINING WALL
SWIMMING POOL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
775-2525
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.
m
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.
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