770133.pdfBUILDING DEPARTMENI
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
W MAILING ADDRESS
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PERMIT N ��
Applicant Fill �. } 1 NUMBER v
Inside Heavy Lines 1�J t
U'n 1
/ �J0 JOR COND. USE NO. DB NO. HEIGHT YARDS , E\1r�,\ ' LOT CO V.E�R'AGE
LEPH NE NUMBER NT I Z SIDE IDO*REAR '� �. ENVIRONMENTAL REVIEW
PROPOSED� ❑COMPLETE XEMPf
NUMBER
❑ YES ❑ N O
STREET R/W ��
EXISTING STREET R/W YJO FT. DEFICIENCY THIS PROPERTY
COMP, PLAN ST. R/W &C) FT. OFT.
CHECK
or Attach Four Copies) STREET AND/OR UTILITY WORK R/W PERMIT REQUIRED
REQ'D. ❑ YES IPNO ❑ YES �T10
UNDERGROUND
WIRING REQ'D. ❑YES VNO
TYPE CONNECTION $►y ES VERIFIEp B
SANITARY SEWER ❑ NO --r
SEPTIC SYSTEM ❑ YES VA;
PERMIT NUMBER
APPVD BY CITY ENG. V
❑ NEW ,RESIDENTIAL ❑ GAS
LINE
❑ NON-RESIDENTIAL ❑ SIGN
ADD
DEMOLISH ❑ RETAINING
❑ ALTER ORCFILLTE ❑ FENCE X_FTI
❑ REPAIR ❑ PRE -MOVE ❑ POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
URE OF WORK TO BE %ONE
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ABUTTING
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REMARKS
0 MCMo "�c
FIRE ZONE I TYPE OF CONS
SPECIAL IN
REQUIRED
❑ YES
PLAN CHECK
NO,
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
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I hereby acknowledge that 1 have read this application; that the in- TOTAL AMOUNT DUE
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
willbe employed in violation of the Labor Code of the State of Washington THIS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
NOTE: Permit Limit One Ye01'(Except DEMOLITIONS and FILL ONLY THE
PERMITS without conditional use permit, which shall be completed in 90 WORK NOTED
days; MOVED -IN BUILDINGS shall be completed in six months) INSPECTION
DEPARTMENT
CITY OF
EDMONDS
L,060
:Tloy- CODE
OUP
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EDMONDS, LOCAL SALES TAX
VALUATION
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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,
wnk
NOTE: Applicant Subject 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.
775-2525
ORIGINAL -file Y LLOW - Ins n',
COLD - r swss r PINK - Owner