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USE
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PERMIT
NUMBER -750422
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION linside Heavy Lines
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WORK R
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SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP LOAD
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❑ YES ❑ NO
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THIS SITE IS LOCATED IN THE CITY
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TOTAL AMOUNT DUE
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tormntlen glven Ie correct; and that I am the owner, or the duly author•
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(zed agent el Ina.I agree to comply with city and State lawn rag.-
ATTENTION
in".. conatruitlort: and la doing the wont authorized thereby, no person
APPLICATION APPROVAL
will be employed In violation or the Labor Code of the State of WzShington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compenaallon Insurance.
AUTHORIZES
elgned by the Building Official or his Dep-
NOTE: Permit Limit One Year which
ONLY THE
iltyi and Pees are paid, and receipt is ac-
-XN(EXCept DINGS halls
.hall 6e completed In Nnety days; MOYED-IN HOD.D1N08 hall be tom•
WORK NOTED
pletcd In .1. ...the.)
INSPECTION
knowledged in space provided.
SIGNATURE (OWNER OR AGENT) OAT SIGNED
DEPARTMENT
41
DIRECTO 1 N E
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CITY OF
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EDMONDS
DATE /
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NOTE: Applicant Subject to Platy Clieck Fee
775-2525
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This Permit covers work to be done on prlVeis property ONLY.
the domain (curbs, sidewalks, drivewayt,
ORIGINAL • FA, YELLOW Inspector
Any construction on public
marquees, ate.) will require separate permission.
PINK • 0,-,er COLD -
CITY TELEPHONE NUMB[
1 STTATE LIG ENSE NUMBER CITY 'LICENSE NUM
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Legal Description Of Property (Show Below or Attach Four Col
STREET AND/OR UTILITY
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CHECKED BY IJW
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❑ YES 1ZW
WORK REQ'D ❑ NO
UNDERGROUND ❑ YES
WIRING REQ'D ❑ NO
TYPE CONNECTION IVERIFIED BY
SEPTIC SY TE ,Y.` E N41MB J IJ I 'I
APPVD BY CI�IYIENr�. L1)- W
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CE SIZE CLEARANCE CH ECH ED BY j
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W
3 �
OF CONSTRUCTION CODE
AREA OCCUPANCY OCCUPANT
GROUP LOAD
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THIS SITE IS LOCATED IN THE CITY w
OF EDMONDS. LOCAL SALES TAX D
SHOULD
D E 0
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in I
VALUATION FEE
PROPOSED YARDS HEIGHT Z
NO.
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❑ NEW
FRONT SIDE REARALLOWABLE
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BUILDING DEPARTMENT Applicant Fill
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PERMIT --I,-_, .-•�'�
NUMBER
SIGN
SIGN AREA SIGN AREAaOTHER
PERMIT APPLICATION Inside Heavy Lines
(
SWIMMING POOL
SPECIAL INSPI
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DEMO /TL
RETAINING
❑WALL
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ADDRESS r
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)
REQUIREMENTS
FENCE
NAM@ (OR NAME OF BUSINESS)
REPAIR
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This application is not a permit until
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LEGAL.LOT
❑
LOT AREA
SUBDIVISION NO.
STREET RtW
UMBER OF STORIESNUMBER
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ELEPH ONE NUMBER
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ATURE OF WORK TO
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STREET AND/OR UTILITY
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II:
CHECKED BY IJW
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❑ YES 1ZW
WORK REQ'D ❑ NO
UNDERGROUND ❑ YES
WIRING REQ'D ❑ NO
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APPVD BY CI�IYIENr�. L1)- W
N 'I
CE SIZE CLEARANCE CH ECH ED BY j
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W
3 �
OF CONSTRUCTION CODE
AREA OCCUPANCY OCCUPANT
GROUP LOAD
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THIS SITE IS LOCATED IN THE CITY w
OF EDMONDS. LOCAL SALES TAX D
SHOULD
D E 0
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D
in I
VALUATION FEE
PROPOSED YARDS HEIGHT Z
NO.
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❑ NEW
FRONT SIDE REARALLOWABLE
RESIDEN TIAL
� LA. INE
FIRE ZONE
PROPOSED
FENCE
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SIGN
SIGN AREA SIGN AREAaOTHER
RETAINING WALL
(
SWIMMING POOL
SPECIAL INSPI
DEMO /TL
RETAINING
❑WALL
REQUIRED
❑ ALTER
❑
REQUIREMENTS
FENCE
❑AN CH EC KES ❑E
REPAIR
rADDRESS
TELEPHONE NUMBERPLANNING
This application is not a permit until
'
AUTHORIZES
DEPT. APPROVAL DATE
i
IPRSPMOVE
POOL
STREET RtW
UMBER OF STORIESNUMBER
knowledged in space provided.
OF
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
INSPECTION
FT. FT.
DWELLING
DIRECTO 5-SIGNATU/rE
COMP. PLAN ST. R/W
CITY OF
�Jl`-J
UNITS
EDMONDS
ATURE OF WORK TO
CITY TELEPHONE NUMB[
1 STTATE LIG ENSE NUMBER CITY 'LICENSE NUM
i
Legal Description Of Property (Show Below or Attach Four Col
STREET AND/OR UTILITY
O
z
II:
CHECKED BY IJW
Z
O
❑ YES 1ZW
WORK REQ'D ❑ NO
UNDERGROUND ❑ YES
WIRING REQ'D ❑ NO
TYPE CONNECTION IVERIFIED BY
SEPTIC SY TE ,Y.` E N41MB J IJ I 'I
APPVD BY CI�IYIENr�. L1)- W
N 'I
CE SIZE CLEARANCE CH ECH ED BY j
IC
W
3 �
OF CONSTRUCTION CODE
AREA OCCUPANCY OCCUPANT
GROUP LOAD
1-
THIS SITE IS LOCATED IN THE CITY w
OF EDMONDS. LOCAL SALES TAX D
SHOULD
D E 0
z
D
J_
D
in I
VALUATION FEE
Z Her .....st
a PLOT PLAN INDICATE BUILDING SETBACK
C ABUTTING STREETS)
N
W
in0
I hereby acknowledge that I have reed this application; that the In•
formation given to correct; and that I am the owner, or the duly author-
Ixed agent of the owner. I agree to Comply with ally and .tats Iowa rsgu•
I.I.I. construetlan; and In doing the work aulhorlred thereby, no person
will be employed In vloiatlon of Ne Labor Coda of the Stale of Washington
relating to Workmen's Compeneetlon In.uraaoe,
NOTE: Permit Limit One Year (Except DE510EJTIONS which
.hall be completed In ¢hely day.; MOVED -IN BUILDINGS shall be com-
pleted In els months.)
IGNATURE (OWNER OR AGENTI GATE SIGNED
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY
v ,
Any construction On the public domain (Curbs, sidewalks, driveways,
marquees, etc.( will require separate permission.
PLAN CHECK
NO.
❑ NEW
RESIDEN TIAL
� LA. INE
FIRE ZONE
FENCE
GN
----R.SJ-..T.ALj[:]
SIGN
❑ ADO
RETAINING WALL
(
SWIMMING POOL
SPECIAL INSPI
DEMO /TL
RETAINING
❑WALL
REQUIRED
❑ ALTER
❑
TE
ORCFILL
FENCE
❑AN CH EC KES ❑E
REPAIR
❑
This application is not a permit until
'
AUTHORIZES
signed by the Building Official or his Dep-
i
IPRSPMOVE
POOL
REMARKS
UMBER OF STORIESNUMBER
knowledged in space provided.
OF
INSPECTION
DWELLING
DIRECTO 5-SIGNATU/rE
CITY OF
�Jl`-J
UNITS
EDMONDS
ATURE OF WORK TO
BE DONE
Z Her .....st
a PLOT PLAN INDICATE BUILDING SETBACK
C ABUTTING STREETS)
N
W
in0
I hereby acknowledge that I have reed this application; that the In•
formation given to correct; and that I am the owner, or the duly author-
Ixed agent of the owner. I agree to Comply with ally and .tats Iowa rsgu•
I.I.I. construetlan; and In doing the work aulhorlred thereby, no person
will be employed In vloiatlon of Ne Labor Coda of the Stale of Washington
relating to Workmen's Compeneetlon In.uraaoe,
NOTE: Permit Limit One Year (Except DE510EJTIONS which
.hall be completed In ¢hely day.; MOVED -IN BUILDINGS shall be com-
pleted In els months.)
IGNATURE (OWNER OR AGENTI GATE SIGNED
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY
v ,
Any construction On the public domain (Curbs, sidewalks, driveways,
marquees, etc.( will require separate permission.
PLAN CHECK
NO.
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
-
TOTAL AMOUNT DUE
,
0
ATTENTION
APPLICATION APPROVAL
-
THIS PERMIT
This application is not a permit until
'
AUTHORIZES
signed by the Building Official or his Dep-
i
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
DEPARTMENT
DIRECTO 5-SIGNATU/rE
CITY OF
�Jl`-J
EDMONDS
C
775-2525
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