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BUILDING DEPARTMENT Applicant Fill
USE PERMIT
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LEGAL LOT VARIANCE OR CONDITIONAL USE
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formation given is correct; and that I am the owner, or the duly author-
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ized agent of the owner. I agree to comply with city and state laws relm.
ATTENTION
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INO D T. A P OVAL DATE:✓a
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will be employed In violation of the Labor Code of the State of Weahmglon
CITY NUMBER
This application Is not a permit until
(TELEPHONE
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EXISTING STREET R/t? :.'....... DEFICIENCY THIS PROPERTY
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NOTE: Permit Limit One Year (Except DEMOLITIONS which
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COMP. PLAN BT. R/ ........FT. '...O...Fr.
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DATE SIGNED
INSPECTION
DEPARTMENT
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Driveway slopes not to exceed those
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ADDRESS
indicated on Standard Dwe. No. 103.
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NOTE: Applicant Subject to Plan Check Fee
EDMONDS
8
775-2525
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I TELEPHONE NUMBER
Any construe),.. on the Public domain (curb., eldew'alke, driveways,
FILE
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STATE LICENSE NUMBER
CITY LICENSE NUMBER N
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REMARKS
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Legal Description of Property (Show Bellow or Attach Four Copies)
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:TOR BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
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REPAIR
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NUBIBER OF STORIES
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NUMBER OF
DWELLING
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NATURE OF WORK
TO
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BE DONE
EXCAVATION OR FILL
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Fee ReceiptNo
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Plan Cheek No. ....................
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BUILDING
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RETAINING WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
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 relm.
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorlmd thereby, no Demon
will be employed In violation of the Labor Code of the State of Weahmglon
THIS PERMIT
This application Is not a permit until
misting to workmen's Compensation Iaaurmce.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac -
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
knowledged In space provided.
Meted in .1. month'.)
SI ATU tE (OWNER ORA T)
DATE SIGNED
INSPECTION
DEPARTMENT
DIREC '8 BIONA E
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p - `I
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CITY OF
NOTE: Applicant Subject to Plan Check Fee
EDMONDS
8
775-2525
This 1'emu{ rark 10 be done on prh'¢le Property ONLY.
Any construe),.. on the Public domain (curb., eldew'alke, driveways,
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marquees, etc., x'111 require .,,,orate p,rmles,on.
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USE PERMIT
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formation given Is correct; and that I nm the owner, or the duly author-
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ATTENTION
UN IREDD YARD¢ PR P SED YARDH
lating construction; and In doing the work authorized thereby, no person
NAME
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This application Is not a permit until
FRONT BIE REAR FRONT BIDE REAR
LEGAL LOT VARIANCE OR CO ITIONAL USE
relating to Workmen's Compensation Imurance.
AUTHORIZES
signed by the Building Official or his Dep -
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NOTE: Permit Limit One Year (Except DEMOLITIONS which
,
ADDRESS t j E8 NO PERMIT NUMIIER
shall be completed In ninety days; MOVED -IN BUILDINGS shall be ccm.
ltnowledged in space provided,
PLaINING DE T. AP '¢OV AL /; DATE:
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pleted In six month.,)
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CITY
TELEPHONE NUMBER
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DIRECTOR'S SIGNATURE / ,
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EX[9 ING STREET R/R!LC)/`I,'1,I . DEFICIENCY THIS PROPERTY
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REMARKS
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This 1'emdn private t coven work to he done u pro petty ONLY.
CHEC EDI BY
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Any construction on the public domain (curb., sidewalks, drlretvnys,
Cl'rY
TELEPHONE NUMBER
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METER BILE SERV CE SIZE CLEARANCE
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STATE LICENSE NUMBER
CITY LICENSE NUMBER ,1 1 /
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REMARKS
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TYPE CONNECTION VERIFIED BY
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SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
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NEW
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
�•�NON-RESIDENTIAL
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��� OF EDMUNDS. LOCAL SALES TAX
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RETAINING
`� SHOULD BE CODED 31.04.
REMARKS
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FENCE
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REPAIR
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NUMBER OF STORIES NUMBER OF
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DWELLING
UNITS
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NATURE OF WORK TO HE DONE
Valuation
Fee
Receipt
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A, t, i-` PI.n Check Nn,/'J = J.
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BUILDING
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F'(✓I IOC/ nJ
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PLUMBING f/. /O
a PLOT PLAN (Indicate Building Setbacks, abutting street,)
HEAT A GAS LINE
21
FENCE
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SIGN
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RETAINING WALL
BWIDIMIN6 POOL
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DEMOLITION
PRE -MOVE INSPECTION
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EXCAVATION OR FILL
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TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
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formation given Is correct; and that I nm the owner, or the duly author-
Ized agent of the owner. i agree to comply with city and elate Inwe regu-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the elate of Washington
THIS PERMIT
This application Is not a permit until
relating to Workmen's Compensation Imurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac -
shall be completed In ninety days; MOVED -IN BUILDINGS shall be ccm.
ltnowledged in space provided,
j
pleted In six month.,)
SIGNATURE (OWNEROFi AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
DIRECTOR'S SIGNATURE / ,
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CITY OF
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EDDIOND9
DATE
NOTE: Applicant Subject in Plan Check Fee
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775-2525
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This 1'emdn private t coven work to he done u pro petty ONLY.
Any construction on the public domain (curb., sidewalks, drlretvnys,
INSPECTOR
mmquer.. els.) will require sepmnle permission,
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