750166.pdfNATURE OF WORK TO BE DONE
Valuation
Fee
Receipt No.
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Plan Check No .....................
BUILDING
PROPOSED USE
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USE PERMIT 750166
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PLUMBING
BUILDING
DEPARTMENT Applicant FILL
2O NUMBER
HEAT A GAS LINE
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PERMIT APPLICATION III81do IleaYy Linos
ADDRESS /,�?- a 9 —
FENCE
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NAME (Olt NAME OF IIUSINEBS)
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LOT AREA TOTAL BLDG. AREA
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DEM 0LITION
CITY LEP O E NUMBER ACTUAL
REG Ili ED 1'ARUB PItOPUBED YARDS
REAR
NAME
FRONT HIDE REAR FRONT SIDF.
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LEGAL LOT VARIANCE Olt CONDITIONAL USE
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❑ YES ❑ NO PERMIT NUMBER
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PI.ANNINO DEPT. APPROVAL GATE:
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APPLICATION APPROVAL
CITY EPHONE NUMBER
lating construction; and In doing the work authorlrad thereby, no person
a;
ITE
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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,
THIS PERMIT
This application is not a permit until
NAME
COMP. PLAN ST. R/W ............FT. ............FT,
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NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
D AI
REMARKScd
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Imowledged in space provided.
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ADDRESS
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AGENT) DATE 1110111111011111116
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BY
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DEPARTMENT
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CITY TELEPHONE NUMBER
(CHECKED
Pee
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METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
NOTE: Applicant Subject to Plarl Check
775-2525
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§TATE LICENSE NUMBER
I CITY LICENSE NUMBER
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FILE
marquee., etc.) will require separate permis.lon.
REMARK.
rrjAttach Four Copies)
Legal Description of Property (Show Below Or
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TYPE CONNECTION VERIFIED BY
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PERC. TEST
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PERMIT NUMBER
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES I] NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
GAB
RESIDENTIAL LINE
(] YES ❑ NO
NEW
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
TAX
NON-RESIDENTIAL SIGN
SH EDMONDS. LOCAL SALES
HO DBE CODED 31.04.
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0 ADD RETAINING
REMA RKS
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DEMOLISH ❑
DEMO
ALTER EXCAVATE FENCE
OR FILL (..........x .......... Ft.)
REPAIR ❑ PRE -MOVE El SWIM
INSP. POOL
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NUMBER OF STORIES NUMBER OF
DNELLING
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UNITS
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NATURE OF WORK TO BE DONE
Valuation
Fee
Receipt No.
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P4Y� S,�K U U
Plan Check No .....................
BUILDING
PROPOSED USE
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PLUMBING
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HEAT A GAS LINE
PLOT PLAN (Indicate Building setback., abutting streets)
FENCE
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SIGN
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RETAINING WALL
ISWIMMING
POOL
DEM 0LITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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TOTAL AMOUNT DUE
Ihereby ncknowladgo that I have read this application; that the In-
tormatlon given Is correct; and that I am the oware, or the duly author-
.
Iced agent of the owner. I agree to comply with city and state laws regu.
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorlrad thereby, no person
will bo employed In violation of the Labor Coda of the State or Washington
THIS PERMIT
This application is not a permit until
fainting to Workman's Compensation Imurence.
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 -
.hall be completed In ninety days; MOVED -IN BUILDINGS shall be cam-
Imowledged in space provided.
pieted In .Ix months.)
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AGENT) DATE 1110111111011111116
INSPECTION
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DEPARTMENT
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CITY OF
Pee
EDMONDS
DAT ((
NOTE: Applicant Subject to Plarl Check
775-2525
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This Prnnit t• ork to bn done an prlrate properly ONLY.
Any construction an the public domain (curb., sidewalks, driveway.,
FILE
marquee., etc.) will require separate permis.lon.