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BUILDING DEPARTMENT Applicant Fill O NUMBER 740490
PERMIT APPLICATION Inside Heavy Linea JOB
NAME (OR NAME OF BUSINESS) ADDRESS
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Arp "IPEFtA718SIBLE ACTUAL 1.
i/ �fo LOT COVERAGE LOT COVERAGE �I
MAILING ADDRESS
C
41 v6a•, frry / L�N�C
CITY) TELEPHONE NUMBER
FRONT'`�� REAR FRONT-- 8IDEan o REAR
RESIDENTIAL
0
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NEN
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regu—
LEGAL LOT VARIANCE OR CONDITIONAL USE
LINE
ADD
0 YES [3 NO PERMIT NUMBER
NON-RESIDENTIAL
❑
SIGN
NOTE: Permit Limit One Year (Except DEMOLITIONS
ONLY THE
DEMOLISH
PLUMBING
HEAT & GAS LINE
RETAINING
WALL
ALTER
completed In ninety days; MOVED -IN BUILDINGS shall be core.
all
EXCAVATE
fQ
plated In elx maneha.)
COMP. PLAN ST. R/W ............FT. ............FT.
❑
ORFILL
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(FCFt.I
REPAIR
❑
PREINSP.-MOVE
❑
awl 'I
POOL
(UMBER OF STORIES
NUMBER OF
SIGN
CHECKED BY
775-2525
DWELLING
SERVICE SIZE
CLEARANCE
CHECKED BY
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UNITS
I
FRONT'`�� REAR FRONT-- 8IDEan o REAR
Plan Check No .....................
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forenn1 given Is correct; and that I am the owner, or the duly author-
7
regu—
LEGAL LOT VARIANCE OR CONDITIONAL USE
person
WIII be employed In violation of the Labor Code of the Slate of Washington
relating to
THIS PERMIT
0 YES [3 NO PERMIT NUMBER
Workmen's Compensation Insurance•
PROPOSED USE
PLANNING DEPT. APPROVAL DATE:(
NOTE: Permit Limit One Year (Except DEMOLITIONS
ONLY THE
STREET R/W
PLUMBING
HEAT & GAS LINE
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
t7
x
completed In ninety days; MOVED -IN BUILDINGS shall be core.
all
OPLOT PLAN (Indleale BUShcng eetaacke, abutting streets)
W
plated In elx maneha.)
COMP. PLAN ST. R/W ............FT. ............FT.
)IGNATURE (OWNER Olt AGENT)DATE SIGNED
REMARKS
xW
C
FENCE
O
fl
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W
13A=
SIGN
CHECKED BY
775-2525
METER SIZE
SERVICE SIZE
CLEARANCE
CHECKED BY
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HEMA1-8
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TYPE CONNECTION
I VERIFIED BY
PLRC. TEST
i PERMIT NUMBER
cd
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REhIARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
I YES NO
SPECIAL INSPECTOR REQUIRED
GROUP
YES NO
IOCCUPANCY
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
Fence requirements — section 12.14.040
attached.
;
Valenti-
Fee Receipt No.
' - - -
Plan Check No .....................
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forenn1 given Is correct; and that I am the owner, or the duly author-
7
regu—
BUILDING
person
WIII be employed In violation of the Labor Code of the Slate of Washington
relating to
THIS PERMIT
This application is not a permit until
Workmen's Compensation Insurance•
PROPOSED USE
NOTE: Permit Limit One Year (Except DEMOLITIONS
ONLY THE
O
PLUMBING
HEAT & GAS LINE
WORK NOTED
ut and tees are aid. and receipt is ac -
y, P P
completed In ninety days; MOVED -IN BUILDINGS shall be core.
all
OPLOT PLAN (Indleale BUShcng eetaacke, abutting streets)
knowledged in space provided.
plated In elx maneha.)
)IGNATURE (OWNER Olt AGENT)DATE SIGNED
INSPECTION
DEPARTMENT
C
FENCE
In
fl
CITY OF
13A=
SIGN
775-2525
This Perndt co— Work to be done Private
n Or property ONLY.
Any canat"
rucllnn nn ihr public dmm�ln (rn rhe, eldrWnikr. drlcen'a>n.
RETAINING WALL
1.1111.111 , nlii i'crnuaalan.FILE
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
hereby acknowledge that I have rend this application; that e In.
m
II
TOTAL AMOUNT DUE
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forenn1 given Is correct; and that I am the owner, or the duly author-
regu—
I agree to Comply with city and elate laws
Iaed ¢gent the owner. work
,,ting construction;
uctlon; n; end In doing the aorK authorized thereby, no
person
WIII be employed In violation of the Labor Code of the Slate of Washington
relating to
THIS PERMIT
This application is not a permit until
Workmen's Compensation Insurance•
AUTIIORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS
ONLY THE
signed by the Building Official or Ills Dep -
which
be
WORK NOTED
ut and tees are aid. and receipt is ac -
y, P P
completed In ninety days; MOVED -IN BUILDINGS shall be core.
all
knowledged in space provided.
plated In elx maneha.)
)IGNATURE (OWNER Olt AGENT)DATE SIGNED
INSPECTION
DEPARTMENT
Dl TOR'S BIONATU )
- fir'`-��!•-`�'�-�6
CITY OF
13A=
NOTE: Applicant Subject to Plan Check Fee EDMON )S
775-2525
This Perndt co— Work to be done Private
n Or property ONLY.
Any canat"
rucllnn nn ihr public dmm�ln (rn rhe, eldrWnikr. drlcen'a>n.
1.1111.111 , nlii i'crnuaalan.FILE
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