750421.pdf750421
DE REAR
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BUILDING DEPARTMENT
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SIGN AREA 1'�v;
OTHER
REQUIREMENTS
750421
DE REAR
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P DEP A ROVAL -.,s-
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PROPOSED USE
Z
PLAN CHECK
❑ NEW
STREET
STREET R/W
RESIDENTIAL
❑LINE
EXISTING STREET /W FT. DEFICIENCY THIS PROPERTY
TYPE OF CONSTRUCTION
CODEi
COMP. PLAN ST. R/W �JQ FT. O FT.
LEPHONE NUMBER
REMARKS
No 06s- enc 7-1,6AI. O/C
U
W
D
CHEC Y
W -
rY LICENSE NUMBER
HEAT & GAS LINE
Z
❑
DEMOLISH
B
Or Attach Four Copies)
STREET AND/OR UTILITY ❑ YES
W
r v
WORK REQ'D NO
❑
OR FILL
UNDERGROUND ❑ VES
❑ YES ❑ NO
WIRING REQ'D ❑ NO
F
Q
PLAN CHECKED BY
THIS SITE
IS LOCATED IN THE CITY
❑
TYPE COr{NEN VERIFIED 0Y
_
SWIML
N❑
OF EDMONDS. LOCAL SALES TAX
YES PERMIT NUMBER
In
1 ^r\)
SEPTIC SYSTEM
APPVD BY CITY ENG. J� ❑ NO
N !
SHOULD BE
REMARKS
I
AUTHORIZES
METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
DEMOLITIONS which
NOTE: Permit Limit One Year -IN
REMARKS
uty; and tees are paid, and receipt Is aC-
W
W
WORK NOTED
REMARKS
h ,
't
3
VALUATION FEE
PROPOSED USE
Z
PLAN CHECK
❑ NEW
NO.
RESIDENTIAL
❑LINE
FIRE ZONE
TYPE OF CONSTRUCTION
CODEi
BUILDING
U
W
NON-RESIDENTIAL
❑ SIGN
D
M
HEAT & GAS LINE
❑ ADD
❑
DEMOLISH
RETAINING
❑WALL
SPECIAL INSPECTOR
REQUIRED
AREA
OCCUPANCY OCCUPANT
GROUP LOAD
❑EXCAVATE
ALTER
❑
OR FILL
[�'I FENCle
n( I jrA /1 X�y,FT)
❑ YES ❑ NO
SWIMMING POOL
F
Q
PLAN CHECKED BY
THIS SITE
IS LOCATED IN THE CITY
❑
PREM OVE
SWIML
I hereby acknowledge that I have read this application; that the In-
OF EDMONDS. LOCAL SALES TAX
REPAIR
❑
INSP,
❑ POOL
lating construction: and In doing work authorised oo person
will be employed In violation of the Labor Code of the Stale of Washington
SHOULD BE
Z
UMBER OF STORIES
AUTHORIZES
NUMBER OF
DEMOLITIONS which
NOTE: Permit Limit One Year -IN
REMARKS
uty; and tees are paid, and receipt Is aC-
0
WORK NOTED
lmowladged In space provided.
Plete n els menthe.)
ghutc
DWELLING
UNITS
5 G AT E IOW 9R O A T) / DATE Sl I"
DEPARTMENT
0
CITY OF
ATURE OF WORK
TO
BE DONE
NOTE: Applicant Subjeci to Plan Check Fee
775-2525
LL
— a
VALUATION FEE
PROPOSED USE
Z
PLAN CHECK
O
NO.
6 PLOT PLANINDICATE BUILDING SETBACKS,
E ABUTTING STREETS)
BUILDING
U
W
PLUMBING
D
M
HEAT & GAS LINE
0
FENCE
_
oUi O D
SIGN
--
RETAINING WALL
SWIMMING POOL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation m given le correct; and that I sthe owner, or the duly author-
leed agent of the owner. I agree to comply with City and state laws resu-
the thereby,
ATTENTION
APPLICATION APPROVAL
lating construction: and In doing work authorised oo person
will be employed In violation of the Labor Code of the Stale of Washington
THIS PERMIT
This application Is not a permit until
relating to Workmen's ComPensatica Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
DEMOLITIONS which
NOTE: Permit Limit One Year -IN
ONLY THE
uty; and tees are paid, and receipt Is aC-
BU
be leled In N days: MOVED -IN BOlI.DIN08 hall 6e com-
WORK NOTED
lmowladged In space provided.
Plete n els menthe.)
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INSPECTION
5 G AT E IOW 9R O A T) / DATE Sl I"
DEPARTMENT
R-Sv91GN AT RE/
CITY OF
/
*0A
EDMONDS
NOTE: Applicant Subjeci to Plan Check Fee
775-2525
LL
— a
This Permit covers work to be done on private property ONLY.
Any on the public domain Icurbs, sidewalks, driveways,
ORIGINAL • fdo YELLOW Lc.pr._lol
construction
marquees, etc.) Will require separate permission.
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