750246.pdfj
NATURE OF WO�1fq IJONE
Valuation
Fee Receipt No.
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BUILDING DEPARTMENT
Applicant FW
ZOO _ la - NUMBIER 750246
PERMIT APPLICATION
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PLUMBING
ADDRESS
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NAME (OR NAME OF BUBINEBS)
Q PLOT PLAN (Indlenlo Building setbacks, abutting streets)
HEAT k GAS LINE
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PERMISSIBLE ID ALOT CTUA
IAT COVERAGE C AGE
SIGN
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PERDIISeI E HEIGHT PROPOSED HEIGHT ;) A
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DEMOLITION
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CITY .i
TELPHONE NUMBER
ACI' L OT AREA TOTAL B IXI. AREA
Nit.
EXCAVATION OR FILL
T75_ tJU
REQUIRED YARDS PROPOSED YARDB
NAME
TOTAL AMOUNT DUE
FRONT SIDF. REAR FRONT BIDE REAR
/Q (J 12-21
I hereby acknowledge that I have rend this application; that the In.
formationrrect; given le coand that I aro the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and elate laws regu-
ATTENTION
APPLICATION APPROVAL
E LOT VA MI CE OR CONVI�NAL UBE
will be employed In violation of the Labor Code of the State of Washington
sUj
ADDRESSES
relating to Workmen's Compensation Insurance.
VMS❑ NO PERMIT NUMBER
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DE51OLITIONS which
ONLY THE
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shallbe completed In ninety days; MOVED -IN BUILDINGS shall be coin-
WORK NOTED
NING EPT. R VA AT
pitted In nix months.)
C
CITY
TELEPHONE NUMBERSTR
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DEPARTMENT
/
CITY OF
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EXIIBET V /
IN STREET R/ DEFICIENCY THI PROPERTY
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NOTE: Applicant Subject to Plan Check Fee
—
NAME
775-2525
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COMP. PLAN BT. R/ M�;.'.(.11 11- ......0 FT.
This Permit covers work to he done an private property ONLY.
Any "n trurtkln on the public domain (curb., sidewalks. driveways,
trm�'er, •'(,'.I I. 111 rrl lllrr e,'n��ritlr l`rrinlnsien.
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REMARKS Driveway slopes not to exceed those
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indicated on Standard Dwq. No.103
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CITY)
TELEPHONE NUMBER
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ME TER BILE SERVICE SIZE CLEARANCE
CHECKED 13YAT
STATE NUDIHE-R�
CITY LICENSE NUMBEti
clary
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7LICENSE
,7_6L.3 `- 02 I.ZC hS
REMARK8 O.K.sewers
D.K. conn et into saninch sewers
Legal Description of Properly (Show Below
or Auden Four Copies)
la
b with no larger line
than 2 -inch
TYPE CONNECTION
VERIFIED BY
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REMARKS
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SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
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CHECK iO THIS SITE S LOCATED IN THE CITY
ElNON-RESIDENT]SIGN
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31 04,S. LOCAL SALES TAX
ADD ❑ DEMOLISH
❑ VAI IiMNG
A CODED
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OR FILL
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DWELL NGUNITS
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NATURE OF WO�1fq IJONE
Valuation
Fee Receipt No.
I�lr-)�9-/(/L///,
Plan Check No .....................
BUILDING
�0
W PROPOSED USE
�n
PLUMBING
W
Q PLOT PLAN (Indlenlo Building setbacks, abutting streets)
HEAT k GAS LINE
h
�
FENCE
SIGN
RETAINING WALL
N
BWIMMIN6 POOL
C,
C7 5 6 -
L
�LSL—
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
/Q (J 12-21
I hereby acknowledge that I have rend this application; that the In.
formationrrect; given le coand that I aro the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and elate laws regu-
ATTENTION
APPLICATION APPROVAL
Intl ngconstruction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application Is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DE51OLITIONS which
ONLY THE
uty; and fees are paid, and receipt is ac-
shallbe completed In ninety days; MOVED -IN BUILDINGS shall be coin-
WORK NOTED
Imowledged in space provided.
pitted In nix months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
I OR' IONAT RE
_
DEPARTMENT
/
CITY OF
EDMONDS
wTE
NOTE: Applicant Subject to Plan Check Fee
—
775-2525
This Permit covers work to he done an private property ONLY.
Any "n trurtkln on the public domain (curb., sidewalks. driveways,
trm�'er, •'(,'.I I. 111 rrl lllrr e,'n��ritlr l`rrinlnsien.
FILE