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BUILDING DEPARTMENT USE PERMIT
PERMIT APPLICATION Applicant Fill ZONE �_ NUMBER `� 052D
Inside Heavy Lines
NAME B
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❑ NEW RESIDENTIAL LINe FIRE ZONEFRONT YPE OF CONSTRUCT N CODE , Q
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DEMOLISH EIWALL RETAINING SPECIAL INSPECTOR AREA
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ALTER EXCAVATE ❑ YES NO x , GROUP
❑ OR FILAD
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PLAN CHECK THIS SITE IS LOCATED IN THE CITY
REPAIR O PRE -MOVE ❑swim OF EDMONDS. LOCAL SALES TAX
INSP, POOL SHOULD BE CODED 31.04.
NUMBER OF STORIES NUMBER OF R A KS
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UNITS F
NATURE OF WORK TO BE DONE Z
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I hereby acknowledge that I have read this application; that the in- TOTAL AMOUNT DUE =dE
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 ATTENTION APPLICATION APPROVAL
will be employed in violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance, THIS PERMIT This application is not a permit
NOTE: Permit Limit One Year(Excepc DEMOLITIONS and FILL AUTHORIZES until signed by the Building Official or
PERMITS without conditional use permit, which shall be completed in 90 ONLY THE his Deputy; and fees dre paid, and
days; MOVED•IN BUILDINGS shall be completed in six months.) WORK NOTED receipt is acknowledged in space pro.
SIGN (OWNER OR AGENT) DATE SIGNED INSPECTION vided.
y�,�� DEPARTMENT R R'S TORE
t'�^ " �" "-eLi 7 t/ CITY OF
NOTE: Applicant Subject to Plan Check Fee EDMONDS AT
775-2525
This Permit covers work to be done on private property ONLY,
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, at will require separate Permisslon. ORIGINAL • Fila YELLOW - Inspector
I GOLD • Assessor PINK • Owner
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