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STREET AND/OR UTILITY ❑ YES
TOTAL AMOUNT DUE
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WORK REQ'D ❑ NO
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UNDERGROUND ❑ YES
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THIS PERMIT
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TYPE CONNECTION VERIFIED
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CITY OF
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NOTE: Applicant Subject to Plan Check Fee
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This Permit covers work to be done on private property ONLY.
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I heresy acknowledge that I have read this appllcatlen: that the In-
I'ormntlon Ewen Is correct: and that I am the owner, or the duty author-
Iced agent of the owner. I agree to comply with city and State laws resin-
ATTENTION
Mung o—trucllOn: and In doing the work authorized thereby, no person
APPLICATION APPROVAL
will he employed In violation of the Labor CAde of the stale Of WMshlDgton
THIS PERMIT
This application is not a permit until
relating to Workmen'. Compensation Imur"Os,
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Escept DEMOLITIONS whlch
ONLY THE
Uty: and fCC9 are paid, and receipt Is ac -
shall be completed In ninety day,: MOVED -IN BUILDINGS .halt be com-
'ORK NOTED
knowledged in space provided.
pleted In ala months.)
INSPECTION
SIGNATURE (OWNER OR AGENT) GATE SIGNED
DEPARTMENT
DIRECTO ' NAT IRE
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
775-2525
GATE
— —
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
ORIGINAL - F0, YELLOW . Impeclor
marquees, etc.) will require separate permission.
PINK • Carter GOLD . Asessrr
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NAME (OR NAME OF BUSINESS)
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LEGAL LOT LOT AREA SV BDIV1510N NO,
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TOTAL AMOUNT DUE
I hereby acknowledge that I have reed this applleallen; that the III
formation given iscorrect; and that I stn the owner, or the duly author•
tOYES ❑ NO IOC}U G 1
Iced agent of the owner. 1 agree to tomplY wllh city and slate laws raN•
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VARIANCE OR ADB NO.
lating construction; and In doing the work aulhorlged parson
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This application is not a permit until
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REQUIREMENTS- 1,//,
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ORIGINAL - File YELLOW - Inspector
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marquees, etc.) will require &operate permission.
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UNDERGROUND ❑ YES I`/r'^-/'_.'"JI-fI
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❑ NON-RESIDENTIAL ❑ SIGN
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❑ ADD ❑ DEMOLISH ❑
RETAINING
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REQUTARED INSPECTOR AREA GROUP JOCCUPA"CY LOAD
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❑ YE5 ❑ NO '!
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NUMBER OF STORIES NUMBER OF
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PENCE
SIGN
RETAINING WALL
SWIMMING POOL
TOTAL AMOUNT DUE
I hereby acknowledge that I have reed this applleallen; that the III
formation given iscorrect; and that I stn the owner, or the duly author•
Iced agent of the owner. 1 agree to tomplY wllh city and slate laws raN•
thereby, no
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work aulhorlged parson
will be emDlayed In v,.,allon of the Labor Code of the State of Wuhloglon
THIS PERMIT
This application is not a permit until
ralnllog le Workman's Compensation lasur"ce.
AUTHORIZES
signed by the Building Official or his Dep -
'
NOTE: Permit limit One Year (E■t.pt IIEMO ATIONN whW1
ONLY THE
uty; and fees are paid, and receipt is Be -
Shall be completed In ninety days; MUVEb•IN BUILDINGS stall be cool-
WORN NOTED
ltnowledged in apace provided.
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plated In elk months.)
INSPECTION
SIGNATURE (OWNER OR AGENT( DATC SIGNED
DEPARTMENT ENT
DIRECTOR'S SIGNATURE
i
clrY of
EDMONDS
DATE r
NOTE: Applicant Subject to I'lan Check Pee
I
PI
775.2525
Thls Permit covers work to be done on private property ONLY.
ORIGINAL - File YELLOW - Inspector
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require &operate permission.
PINK - Owner COLD - Assessor