670057.pdfBUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION inside Heavy Lines
NAME (on NAMM OF BUSINESS)
94 MATIANG ADDRESS
F;2-
CITY TE�FHONE NUMBER
p4�,jf .2V & �5_3ff
454
UTY I T LEPHONE NA
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or
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In4 RESIDENTIAL
GAS
LINE
NEW
NON-REBIDENTIAL
SIGN
RETAINING
F-1
WALL
ALTER
M
DEMOLISH
EXCAVATE
OR FILL
FENCE
( x Ft.)
.......... ..........
REPAIR
1:1
PRE -MOVE
INSP.
E]
sW7M
POOL
ES
NUMBER or
DWELLING
UNITS
W
NUMBER
RESS
V L/
1 0
USE ZONE LOT AltN
YES NO
fBER
RTY
EXISTING STREET R/W ............ FT- DEFICIENCY THIS PROPE_111
COMP. PLAN ST. R/W ............ FT- ......... FT.
REMARKS
CREOXED BY 10
z
MZTER SIZE I SERVICE SIZE LEARANCE CREC By
Ej YES 13 NO
Plan Check No .... ...............
PROPOSED USE
BUILDING
PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
"C-alilc ec
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMTNG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given to correct; and tbut I ' 'anu the owner, or the. dill ' y. author-
ized agent of the owner. I agree to comply with city and state laws regu.
ATMDMON
letting 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 PERMIT
relating to Workmen"s Compensation Insurdnee.
AUTHORIZES
ONLY TIM
NOTE: Permit Urnit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
E3113NATURE (OWNER OR AG!�� E SIGNED
INSPECTION
DEPARTMENT
2- 32
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Cbeck Fee
rn 6.1107
This yermit Covers work to be done on private property OINJ61.
Any Construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
0 YES 0 NO
Valuation I Fee
��. 0 0
No.
I .::mw - U Ij I -
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-
Imowledged in space provided.
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RECORD OF INSPECTIONS
Date Passed
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Drainage
Sewer
Parking
Landscaping
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plumbing (Partial)
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