670020.pdfBUILDING DEPARTMENT Applicant FIR
Inside Heavy Lines
PERMIT APPLICATION
NAME (OR NAME 0 )USINESS)
0
,��g�AXE
M A TLJNG ADDRESS
GITY
NAME
iR,
C
i TELE ONE NUMBER
4/5
N�A �ME
ADDRESS
/6
Z 6
8
STATE LICENSE NUMBER CITY LICENSE NUMB=
0/ 7 0 ��o K—)
Legal Description of Property (Show Below or Attach Four Copies),,.
F1NEW
ED —RESIDENTIAL
I
El
GAS
LINE
ElADD
El NON-RESIDENTIA.L
El
SIGN
RETAINING
ElDEMOLISH
WALL
ElALTER
EXCAVATE
El OR FILL
PENCE
( x Ft.)
.......... ..........
E]
PRE -MOVE
REPAIR Q INSP.
ED
swim
POOL
S
NUMBER OF
DWELLING
UNITS
PERMIT
NUMBER 670020
.3 — 7e 04-
Ps - s q I
wxl� X IS/ W
EXISTING STREET R/W 4 ...FT. DEFICIE
COMP. PLAN ST . R JW .64 ... FT.
REMARKS
METER,SIZE I SERVICE SIZE
ZZL(l
I CLEARANCE
1
MARKS
TYPE CONNECTION
VERITI
PERC. TEST
REMARKS
FIRE ZONE I TYPE OF CONSTRUCTION
REAR YARD SETBACK
VACANT SITE
NO
VARIANCE NUMBEK
ow
THIS PROPERTY
10 YES g] NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
_r
E] YES 0 NO
PLAN CHECKED BY
REMA,RKS'
Plan Check No ............ . .......
BUILDING
PLUMBING
streets)
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given to correct; and that I arn the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
lating construction; and in doing the work authorized thereby. no Person
will be employed In violation of the Labor Code of the State of Washington
THIS PER1%IIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WOIUE NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
;IGNATUR.E (OWNER OR AGENT) I DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquess, etc.) will require separate permission.
Valuation
Fee
1,7dl- 1��o I
Z
Z t
tA I t
No.
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
Kom
,6
RECORD OFINSPECTIONS
Date Passed
Foundation
f4--
Plumbing (Partial)
(Rough)
Frame
Furnace & Fuel Un lftj. .
. . . . . . . . . . . . . .
Final