740086.pdf-
BUILDING DEPARTMENT AppU.tFiu ZONE
PERMIT APPLICATION I Inside Reay Lines
A.
04 MAILING ADDRESS
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CITY
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NAME
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NAME
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COMP.
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TYPE OF
'ECTOR RE
YES 13 NO
I hereby acknowledge that 1 6nva rend this application; that the In.
formation given Is correct; and that I am the owner, or the duly autber-
❑ RESIDENTIAL
❑
GAS
YES "" I C.f — t
C)ss
ATTENTION
NEW
lating construction; and In doing the work authorizad thereby, no person
LINE
will be employed In vlolatlos of the Labor Code of the State or Weshmgton
PLAN CHECKED x THIS SITE IS LOCATED IN THE CITY
This application is not a permit until
relattog to Workmen's Compensation Insurance.
❑ NON-RESIDENTIAL
❑
SIGN
ONLY THE
WORK R011R NOOTETE D
OF EDMONDS. LOCAL SALES TAX
shall be completed In Nsaly days; MOVED -IN BUILDINGS shall be cora-
❑ ADD
DEMOLISH
❑
RETAINING
WALT
-�/� cH0 lLD SE CODED 31 04
RE RKS
INSPECTION
❑
EXCAVATE
FENCE
PJ 0,90- iy]a
-NOTE:
ALTER
❑ OR FILL
❑
(..........s........../�
Ft.)
_
❑ REPAIR
❑ INSP.
❑
swim
POOL
�♦//J� CZr J %O Off{,! .� �TEr ��iY4 ✓✓-!/•�S
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO DE DONE
Valuation
Fee Receipt No.
Plus Check No— .............. ...
BUILDING
1
LO
1O
Y PROPOSED USE
/
--
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PLUMBING
V
PLOT PLAN (Indicate Rullding setbacks, abutting
streets)
HEAT k GAS LINE
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FENCE
1 I
SIGN
RETAINING WALL
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rl o-
µyd C�
N
I
SWIMMING POOL
J
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DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILLr
I hereby acknowledge that 1 6nva rend this application; that the In.
formation given Is correct; and that I am the owner, or the duly autber-
TOTAL AMOUNT DUE
I
O0
I
Ized agent of the owner. I agree to comply with city end elate laws ngu-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorizad thereby, no person
will be employed In vlolatlos of the Labor Code of the State or Weshmgton
THIS PERMIT
This application is not a permit until
relattog to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK R011R NOOTETE D
uty; and fees are paid, and receipt is ac -
shall be completed In Nsaly days; MOVED -IN BUILDINGS shall be cora-
knowledged In apace provided.
pleled In six months.)
el TURE (OWN OR AOEN'Ip _. DATE SIGNED
INSPECTION
Dl TO NPILEDEPARTMENT
CITY OFEDMONDSOATH
-NOTE:
Applicant Subject to Plan Check Fee
es o-ltol
_
This P,—It a c,k to be don, on Private property ONLY.
:\ny conelruclient nthe pubtic damwa
ata (curbs, sldrlks, drlvewrys,
TOGETHER WITH THE SOUTH HALF OF VACATED ALLEY ADJACENT THERETO.i