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USE
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NAME
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NAME (ORy NAME OF USINESSI
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ADDRESS
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CITY OF
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MAILING ADDRESS
775-2525
El YES ❑ NO
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REMARKS
Any construction on the public domain (curbs, sidewalks, driveways,
VARIANCE OR
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OF STORIES NUMBEROF
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CITV TELEPHONE
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signed by the Building Official or his Dep -
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5UB IVISION NO.
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DATE
FT. DEFICIENCY THIS PROPERTY
FT. FT.
or Attach Four Copies) STREET AND/OR UTILITY LJ YES
WORK RED'D ❑ NO
UNDERGROUND ❑ YES
WIRING REQ'D ❑ NO
TYPE CONNECTION VERIFIED BY
SEPTIC SYSTEM
❑ YES PERMIT NUMBER
APPVD BY CITY ENG. ❑ NO
METER SIZE ISERVICE SIZE
❑
NEW
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GAS
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SPECIAL INSPECTOR
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ALTER
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NUMBER 750420
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❑ YES ❑ No
PLAN CHECKED BY
THIS SITE
IS LI
CITY OF
REPAIR
0
SWIM
POOL
EDMONDS.
SHOULD BEcc
775-2525
DA` 3- .7
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This Permit covers work to be done on private property ONLY.
REMARKS
Any construction on the public domain (curbs, sidewalks, driveways,
NUMBER
NUMBER
OF STORIES NUMBEROF
tREA
5UB IVISION NO.
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DWELLING
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FT. DEFICIENCY THIS PROPERTY
FT. FT.
or Attach Four Copies) STREET AND/OR UTILITY LJ YES
WORK RED'D ❑ NO
UNDERGROUND ❑ YES
WIRING REQ'D ❑ NO
TYPE CONNECTION VERIFIED BY
SEPTIC SYSTEM
❑ YES PERMIT NUMBER
APPVD BY CITY ENG. ❑ NO
METER SIZE ISERVICE SIZE
❑
NEW
jr—iRESIDENTIAL
GAS
LINE
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ENTIAL
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RETAINING
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❑ OEMOL151H
SPECIAL INSPECTOR
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pleled In Ill. month..)
AREA
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GROV
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❑ YES ❑ No
PLAN CHECKED BY
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REPAIR
❑PRE-MOVEOP
INSP.
SWIM
POOL
EDMONDS.
SHOULD BEcc
775-2525
DA` 3- .7
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This Permit covers work to be done on private property ONLY.
REMARKS
Any construction on the public domain (curbs, sidewalks, driveways,
NUMBER
NUMBER
OF STORIES NUMBEROF
marquees, otr..) will require separate permission.
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DWELLING
UNITS
PLAN CHECK
NO.
JILDING SETBACKS,
STREETS) BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
OCCUPANT
LOAD
1-
IN THE CITY w
SALES TAX D
VALUATION I FEE
I hereby acknowledge that I have rend this application; that the In.
TOTAL AMOUNT DUE
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formation Riven Is correct; and that I nm the owner, or the duly wthor-
Ized agent of the owner. I agree to comply with city and stale lawn rogu-
lating coastructlon; and In dolog the work authorized theroby, ao Darson
ATTENTION
APPLICATION APPROVAL
will be employed In violation of Ura Labor Code of the State of Wuhington
Compensation Imurwee.
THIS PERMIT
This application is not a permit until
relating to Workmen's
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (E.cept DEMOLITIONS which
ON LV THE
uty; and fees are paid, and receipt is ac-
shall be completed In nicety day.; MOVED -IN BUILDINGS shell be cam•
pleled In Ill. month..)
WORK NOTED
knowledged in space provided.
INSPECTION
IGN ATURE (OWNER OR AGENT) DATE SIGN7E D(
DEPARTMENT
DI�R'SATj
CJ`
CITY OF
/ /
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
775-2525
DA` 3- .7
/G\7
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
ORIGINAL -File YELLOW -Inspector
marquees, otr..) will require separate permission.
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