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W1.111DING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR N ME OF BUSIN SS)
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ADDRESS
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ALLOWED
REMARKS
LAN
PERMIT
NUMBER 7 %J063
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SIDE
PROPOSED
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STREET R/W
EXISTING STREET R/W
COMP, PLAN ST. R/W
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REAR
ENVIRONMENTAL REVIEW
10 COMPLETE ❑ EXEMPT
FT. DEFICIENCY THIS PROPERTY
FT. FT.
CHECKED By
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NUMBER CITY LICENSE NUMBER
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Property (Show Below or Attach FOUf Copies) STREET AND/OR UTILITY
WORK
R/W PERMIT REQUIRED
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UNDERGROUND
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TYPE CONNECTION
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VERIFIED BY
SANITARY SEWEF2
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NO
SEPTIC SYSTEM
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PERMIT NUMBER
APPVO BY CITY ENG.
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YES
NO
REMARKS
METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
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REMARKS Q
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NEW RRESIDEN TIAL ❑ LINE FIRE ZONE TYPE OF CONSTRUCTION CODE
❑ ❑ NON-RESIDENTIAL ❑ SIGN ADD ❑ DEMOLISH ❑WALL LREQUIRED
RETAINING
ALTER EXCAVATE FENCE OR FILL ( XFT)REPAIR PNSP. E POOswim
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NAj.jJRE OF WORK TO BE DONE
E [\^ n PLAN CHECK
ODIC TE BUILDIN SETBACKS,
ABUTTING STRE S) BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
R (AREA
I herd)% acknowi9 dcc that I ha\'e read this applicajdul�
hat the in. TOTAL AMOUNT DUE
Iorniation Ci\'eil is cot -recta and that l ;till the Owmcr, orly author-
ized agent of the o\\'tler. 11_ree to tor:ply with city anlaws regu- gTTENTION
IatinC cons:ra:tion; .ind In donut the \\i?:k authorized th, no person
lc llh be CP.ij)lo\'ed 111 \loiatlO it i)i lhle l.3bcu Code of the StVashinitton THIS PERMIT
relatltiz to \t Crk lltetl C_ornpensa:lu❑ Ins::rance.AUTHORIZES
ONLY THE
NOTE: Permit Limit One Yearuxcept DF�Ious and FILL NfORK NOTED
PFR>IITS \\ithout ;onditiona' use pennil, which shall bleted in 90daps; MOVED -IN BUILDINGS shall be completed months.) INSPECTION
SIGNATURE ;O\VNER OR AGENT DAN D DEPARTMENT
7 CITY
EDMONDS
VOTE Applicant 5ubiec: to Plan C le-ck Fee 775 2525
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.
ANT
GROUP (LOAD
F.
THIS SITE IS LOCATED IN THE CITY w
OF EDMONDS. LOCAL SALES TAX O
SHOULD BE QQDEQ 31,04,U
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VALUATION I FEE
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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.
DIRECTOR'S SFCNATU Ei _
i
DATE
01�- t3 " / It
ORIGINAL - F0, YELLOW - Inspector
GOLD - Assf:-cur PINK - Owner
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T OTKEPERMITTEE AND/OR OWNER 1 y,
P RTIAL APPROVAL f44
❑ IOLATION
�' CORRECTIONS REQUIRED
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PERMIT }'
NUMBER�� t
JOB ADDRE89
NO PERMIT - STOP WORK - REMOVE CONSTRUCTION OR OBTAIN
PERMIT AND D4AKE WORK COMPLY WITH BUILDING LAWS.
❑CONSTRUCTION IS NOT IN ACCOR.DALtiCE 1VITII APPROVED PLANS
AND PERMIT - STOP WORK. MAKE EXISTING WORK COMPLY WITH
APPROVED PLANS AND PERMIT OR REMOVE IT.
El S P WORK - UNTIL, AUTHORIZED TO CONTINUE BY INSPECTOR.
CORRECTIONS LISTED BELOW MUST BE MADE BEFORE WORK CAN
BE APPROVED.
(-j WORK DESCRIBED 13EWW HAS BEEN INSPECTED AND IS APPROVED.
lt�❑JJ CONTACT INSPECTOR AND -- ❑'RECALL FOR INSPECTION.
- ARRANGE FOR APPOINTMENT.
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THE ACTION�S,7 OR CORRECTIONS TNTDICATED ABOVE ARE REQUIRED
WITHIN 'r-- DAYS OR .PENALAWLTIES IMPOSED BLAWMAY BE
y-hgL OR INSPE7TIOKiS CALL: 775-2525.
11 NG D[V.
INSPECTOR f� ❑ PUBLIC WORKS
CITE O `'� ,_..« f ❑FIRE DEPT.
EDMONDDATE
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