660542.pdf0 DEPARTMENT
. APPLICATION
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Applicant FIU
Inside HeavY Lines
LICENSE NUMBER CITY LICENHE rivae-an
Description or=perty (Show Below or Attach Four COPICA)
PtIL< --k It S" C. V)
NEW
to RESIDENTIAL
I
n
GAS
LINE
EJE
NON.RrSIDENTIAL
SIGN
ADD
ElDEMOLISH
RETAINING
WALL
ALTER
n
EXCAVATE
OR FILL
FENCE
( .......... x .......... Ft.)
REPAIR
1:1
PRE -MOVE
INSP.
SWIM
POOL
;UMBER Or STOMES
NUMBER OF
DWELLING
I I UNITS I
-NATURE OF WOOF —TO BE DONE
L
t
�v
S13X ONS
I tya,
I hereby acknowledge that I have read this applica6tion; that the In-
formation given is correct; and that I am the owner, or the duly author-
ized agent of tile owner. I agree to comply with city and state laws regu-
latIng conaruction; and In doing the work authorized thereby. no Person
will be employed in violation of the Labor Code of the Slats Of WaJ'btngtOn
relating to WorkmeWs Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS Which
shall r, completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months-)
W - Q-�L —6 b
NOTE: APPlicant Subject to Plan Cbeck Fee
This permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs. sidewalks, driveways.
marquees, etc.) will require separate permission.
C
NO.: PERMIT
NUMBER
EXISTING STREET R/w ............ FT.
C!OMP. PLAN ST. R/W ............ FT -
YES [3 NO
Plan check NO ................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMNG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
13 YES 13 NO
DEFICIENCY TIUS PROPERTY
Valuation
[] YES [I NO
Fee
1 S19
No.
1 7, S-V r 3 4� *
APPLICATION APPROVAL
This application is not a pernift until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
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PL
'APPLICATIONC., BUILDING PERMIT
..........
Appl. No.
F EDMONDS Building Department Permit limit, one year
CITY 0
APPLICATION is hereby made for a permit to construct the followmg work, in accordance with the accom,
law and speci i submitted herewith for approval.
panying p f i7cat,,.,Two
new alter Off -St.
Work addn
..... ......................
9
repair ... * ...
...... Parkin
Fk zone
ncy............................... Const.
type ............
a ...................
se zon
...........................
. . .......... .....
............. r" ... **'** ...
ego(
............
Lot ....... ..............
Blk ......
.........
P ........ A dn.� ....... ..... ............
. L ; o . t' frontage ........................................ Area ........................................... Septic tank ..........................................................
..................
front .... . ......... r. side .............................. 1. side.� ................ rear.
............... Address./�.. ..... T
Builder.................................................................... Address .................................................... Tel. No .............................
P"".Plans by ................................................................. Address .................................................... Tel. No .............................
Plumbing:
"F: This pealinit COVOrs Work to be done
. ............................................................
';�x .........................
Remarks ...... M
Any on tlle public doMMctree
...... ................. ................
.....................
etc. :roquire separate pcl-m..�
3 slo n
The above is a correct statement, and I agree to comply wiA i��plicable Codes and State laws - regulating this
work.
Signed
......... Date-& >Lf
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the ap,
proved plans and specifications, and Building Departni t notations
valuation .......... ......... Permit fee ..... :0.8 .............
Building Department, By ...................................... . &C. �- ..............
NOTE — This permit does not cover plumbing, sewer, or electrical installations, nor does it Permit any work to be
done in the Right of Way areas. Driveways and walkways must be planned to meet the official grades of streets
and alleys, and plans for future sidewalk development.
I