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ItRo ES ❑ NO
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SPECIAL 1NSPEUCTOR REQUIRED
❑ YES O
OCCUPANCY GROUP
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❑ RESIDENTIAL ❑ LINE
PLAN CHECKED BY
THIS SITE I LOCATED IN THE CITY
❑ NEW
® NON-RESIDENTIAL 1:1slaN
OF EDMONDS. LOCAL SALES TAX
CO/DED 31.04.
USE
PERMIT �n..1
NUMBER
REMARKS
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AGE
NATURE� WORK TO BE DONE
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PERMItltlIBLE HEIGHT
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Plan Check No .....................
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ACTUAL LOT AREA
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TOTAL ARE
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REQUIRED YARDS
PROPOSED YARDS
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V PLOT PLAN (Indlcato Building eetbacka, abutling Slice e)
NAME
FRONT SIDE
REAR FRONT BIDE REAR
FENCE
SIGN
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LEGAL L ATOVARIANCE OR CONDITIONAL USE
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ADDRESS
O YES (3 NO PERMIT NUMBER
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PLANNING DEPT. APPROVAL DATE:
PRE -MOVE INSPECTION
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TELEPHONE NUMBER
TOTAL AMOUNT DUE
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1 hereby acknowledgo that I have read this application; that the In-
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STREET A/{V
EXISTING STREET R/W ............FT.
DEFICIENCY THIS PROPERTY
V
ATTENTION
APPLICATION APPROVAL
NAME
s:_—_,4—as:_—_,4—a dr /1 �• �
COMP. PLAN ST. R/W ............p'r.
............FT.
P?
THUS PERMIT
REMARKS
relating to Workmen's Compensation Insurance.
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As' 7J300
0
a
ItRo ES ❑ NO
1
SPECIAL 1NSPEUCTOR REQUIRED
❑ YES O
OCCUPANCY GROUP
�—/ JA ---Z
❑ RESIDENTIAL ❑ LINE
PLAN CHECKED BY
THIS SITE I LOCATED IN THE CITY
❑ NEW
® NON-RESIDENTIAL 1:1slaN
OF EDMONDS. LOCAL SALES TAX
CO/DED 31.04.
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REMARKS
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Valuation Fee Receipt No.
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PLUMBING
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HEAT A GAS LINE
FENCE
SIGN
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WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL.
TOTAL AMOUNT DUE
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1 hereby acknowledgo that I have read this application; that the In-
formation given le correct; and that I am, the owner, or the duly author-
Ired agent of the owner. I agree to comply with city and elate laws regu-
ATTENTION
APPLICATION APPROVAL
lacing construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THUS PERMIT
This application is not a permit lentil
relating to Workmen's Compensation Insurance.
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 Be
shall be completed In ninety days; MOVED -IN BUILDINGS shall be
knawledged ill.pace provided.
pleted In six mons .)
BlCyp�A' Ufl{i O NER OR AGE ) DATE SIGNED
INSPECTION
TUBE,
DIRE O S16\
DEPARTMENT
c� i
CITY OF
Plan Check Fee
EDMONDS
ATE %
NOTE: Applica object to
775.2525
;
This Permit rorero work to be dons en private property ONLY.
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Any consfrnetion pn the public domain (curb., nldewalks, driveway°'
FILE
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