750407.pdfUSE PERMIT
BUILDING DEPARTMENT Applicant Fill ZONE �NUMBER 750407
PERMIT APPLICATION Inside Heavy Lines ,OB _ '
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NAME (OR NAME OF BUSINESS) �(
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PLANNING DEPT. APPROVAL DATE 1 ,
NAME
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UNDERGROUND ❑ YES
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I hereby acknowledge that I have read this application; that the In' TOTAL AMOUNT DUE
formation given Is correct; and that I ach the owner, or the duly author.
Ired agent of the owner. I agree to comply with city and state laws NEU ATTENTION APPLICATION APPROVAL
luting eonetructloo; and In doing the work authorised thereby, no person
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT permit until
relatlag to Workmen's Compensation Insurance. AUTHORIZES This application 19 not 8 p
ONLY THE signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DINGS shall which yy0RK NOTED utyi and fees are paid, and receipt is ac-
ple to 6c completed months.)
to meaty days; MOVED -IN HOD.DINOH shell be cam• ltnowledged in apace provided. -
pletrd In els menthe,)
INSPECTION
SIGNAT RE (O ER OR AG NT) GATE SIGNED OEPARTMENT DIRECTO IG E
CITY OF
EDMONDS DATE
NOTt:'. Applicant ,Subject to Plan Check %ec 775-2525 e— Z _7 S
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This Permit eovors wodt to ba done on private property ONLY. ORIGINAL - Fdc YELLOW - Inspc-icr
Any ConstruetIn. on the public domain (curbs, sidewalks, driveways,
marquees, ate.) will require separate permission. PINK - Owner GOLD. A;ceserr ,
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STATE LICENSE NUMBER CITY LICENSE NUMBER
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STREET ANO/OR UTILITY ❑ YES
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WORK REQ'D ❑ NO
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❑ ALTER E:]. -CA -AT. FENCE
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PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
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REPAIR INSP O POOL
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I hereby acknowledge that I have read this nppltcation; that the In-
TOTAL AMOUNT DUE
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tormation given to correct; and that I am the owner, or the duly author -
Iced agent of the owner. I agree to comply with city and stale Tawe ngu-
thereby, no
ATTENTION
APPLICATION APPROVAL
fating construction; and in doing the work authorised person
will be employed In violation of the Labor Code of the Slate 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 DEMOIJTIONS which
ONLY THE
llty; and fees are paid, and receipt !s ac-
ehalt be completed In ninety days; MOVED -IN BUILDINGS shall be tam•
WORK NOTED
ltnowledged in apace provided.
plated In six month..)
INSPECTION
SIGNATURE )OWNER OR AGENT) SIGNED
DEPARTMENT
DIR ECTOR'S. SIGNATURE
JCATr
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CITY of
`�•( 11 /._ ,Fj... .r
EDMONDS
DATE
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NOTE: Applicant Subject to Plant Check Pec
775.2525
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This Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, $idewalks, driveways,
ORIGINAL. Filo YELLOW - I„spectot
)
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marquees, etc.) will require separate permission.
PINK - 0 e COLD - Aszesvrr
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