670074.pdfI
I
BUILDING DEPARTMENT I Applicant =
PERMIT APPLICATII Imide Heavy Unes
S
. P_ //A/.? 6/ P
6) W r) r".
Pa Q, e- 6
NEW
RESIDENTIAL
El ADD
NON-RESIDEN
ALTER
DEMOLISH
EXCAVATE
OR FTLL
E] REPAIR
PRE -MOVE
INSP.
DwELIANG
UNITS
NE
- # I
,_ 3_�-,6 7
FAWLL MAP No.: PERMIT
ER
NUMB
ks AVVIM513
a 30'�41
�-g . jjjjjjjjssM=�
STRXICTW
MPHONE NUMBER EXISTING STREET R/W ........... XT,
COUP. PLAN ST. R/W ............ FT,
0 S'
MGAS
V
LINE
SIGN
RETAINING
WALL
PENCE
( ........ x .......... Ft.)
SWIM
POOL
YES
I
Plan Check, No ..............
BUILDING
PLUMBING
HEAT & GAS LINE
t
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the In-
formation given is correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws regu.
lating construction; and In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Waahingtou
rels,ting to WorkmeWs Compensation Insurance.
NOTE: Permit Umit One Your (Except DEMOLITIONS which
shoal be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six month
3
--3-67
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private Property ONLY -
Any construction on the public domain (turbo, sidewalks, drIvew"s,
mwquw% etc.) will require separate permission.
TOTAL AMOUNT DUE
Valuation
�2' C '�)
670074
F �YARDSETIE
/.I- I /V)/'
C) YES
13 NO
THIS PROPERTY
,8&pelte
13 YES
Fee
*5.e
b�14
El
Z
L
ATTENTION APPLICATION APPROVAL
THIS FEBMI[T This application is not a permit until
AUTHORIMPS signed by the Building official or Ms Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION DIRECTOWS SIGN7
DEPARTMENT I
CITY OF DATV
EDMONDS
PR 6-1107