740191.pdfNATURE OF WORK TO BEDO iE _
Vuluntlan
Fee Receipt No.
Check No .....................
INSPECTION
DEPARTMENT
BUILDING
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y PROPOSED USE
4 PLUMBING
DIRECT R' elONATURE
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PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT @ GAS LINE
Y
—
DATE
t
FENCE
—
SIGN
RETAINING WALL
BWIMMIN6 POOL
PERMIT �� 19
UTNE I 7 /
DEMOLITION
PRE•MOVE INSPECTION
BUILDING DEPARTMENT
Appllcautinn
NUMBER
)
TOTAL AMOUNT DUE
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PERMIT APPLICATION
Inside Heavy Lines
JOB
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APPLICATION
This application
formation given ie correct: and that I am the awmer, or the duly author.
Imd agent oI the owner. I agree to comply with city and state law. regu- ATTENTION
lating construction; and In doing the work authorised thereby, no person
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT
AUTHORIZES
APPROVAL .
is not a permit until
ADDRESS
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NAME (OR NAME --se" OF
^ A
PERMIdBIBL-
ENT COVERAO?
ACTUAL
LOT COVAAGE
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PERMISSIBLE HEIGHT
PROPOSED HEIGHT
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AREA
CITY
TE ONffi N'U'MLByiR
ACTUAL LOT AREA
TOTAL BLDG.
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7' �'i� { Q
REQUIRED YARDS
PROPOSED YARDS
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FRONT SIDE REAR
FRONT BIDE REAR
NAME
LEGAL LOT VARIANCE
OR CONDITIONAL USF.
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ADDRESS
0 YES ❑ NO PERMIT NUMBER
yH
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PLANNING DEPT. APPROVAL
DATE:
UTELEPHONE
CITY
NUMBER
STREET R/W
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EXISTING STREET R/W ...........
DEFICIENCY THIS PROPERTY
NAME
COMP. PLAN ST. A/W ............FT.
............FT,
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REMARKS
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td ADDRESS
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CHECKED BY
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td CITY
TELEPHONE NUMBER
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METER SIZE
SERVICE SIZE
CLEARANCE
CHECKED BY
U STATE LICENSE NUMBERI
CITY LICENSE NUMBER
REMARKS
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Legal Description of Property (show Below or Attach Yoourr C/ooPIte)
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TYPE CONNECTION
VERIFIED BY
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PERC. TEST
PERMIT NUMBER
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REMARKS
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FIRE�.'O/Nffi TYPE OF CONSTRUCTION STREET IMPROVED
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❑ YES [I NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
RESIDENTIAL
GASE
LIN
No
❑PLANBCHECKEIODY
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NEW
THIS SITE IS LOCATED IN THE CITY
TAX
❑ NON-RESIDENTIALeicx
OF EDD BE LOCAL
3A 04 SALES
i
ADD
ElDEMOLISH
❑ RETAINING
A
REMARB
IC
ALTER ❑ ORFILL EXCAVATE
❑ PENCE x..........Ft.)
E] REPAIR ❑ PRE -MOVE
INSP.
O swim
POOL
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NUMBER OF STORIES NUMBER OF
-
DWELLING
UNITS
NATURE OF WORK TO BEDO iE _
Vuluntlan
Fee Receipt No.
Check No .....................
INSPECTION
DEPARTMENT
BUILDING
[[[0
y PROPOSED USE
4 PLUMBING
DIRECT R' elONATURE
'j/.//
U
PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT @ GAS LINE
Y
—
DATE
t
FENCE
—
SIGN
RETAINING WALL
BWIMMIN6 POOL
DEMOLITION
PRE•MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
�• 7�6
I hereby acknowledge that I have Is. this application; that the In.
i�
APPLICATION
This application
formation given ie correct: and that I am the awmer, or the duly author.
Imd agent oI the owner. I agree to comply with city and state law. regu- ATTENTION
lating construction; and In doing the work authorised thereby, no person
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT
AUTHORIZES
APPROVAL .
is not a permit until
reiatin6 to Workmen. COmpeneatloh Iasurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in Moldy days: MOVED -IN BUILDINGS .hall be cord.
ONLY THESigned
WORK NOTED
by the Building Official or Me Dep -
uty: and fees are paid, and receipt is ac -
knowledged In space provided.
pitted In Rits mouth-.)
IIBAIATUE (OWNER ORA DAT S10NED
INSPECTION
DEPARTMENT
DIRECT R' elONATURE
'j/.//
CITY OF
EDMONDS
PR 6.1107
Y
—
DATE
t
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done .n private property ONLY.
Any ccaslructicn sa the public domain (,orbs, sidewalk., drive.".,
,..argues., etc.) will require .eparnte P-MI-.lon,
FILE
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