670205.pdf7_1 i,
WING DEPARTMENT Applicant Fill
WAIT APPLICATION Inalde Heavy Lines
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NAME
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RESIDENTIAL
NON-RESIDENTIAL
DEMOLTS
EXCAVATE
OR FILL
PRE -MOVE
INSP.
DWELLING'
UNITS
n-
GAS
LINE
ElSIGN
RETAINING
WALL
PENCE
( .......... x .......... F
SWIM
POOL
APERMIT
"/ I NUMBER
670205
B ADDRESS
DE YARD sErBAC
STREET SETBACK
nEAR YARD SETBACK
LOT AREA
VAC 11ITE
YES Cl NO
BUILDING ARZA
VARIANCE RUMBER
Pw
PLOT PL.Idl APE1116VED
STREET R/W
EXISTING SMELT R/W ............ FT.
COMP. PLAN ST. R/W ............ FT-
DEFICIENCY THIS PROPERTY
....... .... 77.
0
REMARKS
I
CHECKED BY
z
METER SIZE I SERVICE SIZE CLEARANCE
CHECKIM By
REMARKS
TYPE CONNECTION
VERIV11111) BY
PERO. TEST
PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
13 YES [3 NO
SPECIAL INSPECTOR REQUIPIED
0 YES C] NO
OCCUPANCY GROUP
Pr CHECKED BY
REMARKS
it
N
I
1 hereby acknowledge that I have read this application; that the In.
formation given in 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 Washington
relating to WorkmtWx Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
P,;Fr%, jr�
OR
00
VAII 14
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NOTE: Applicant Subject to Plan Chech. Fce
This parallt covers work to be done on prIVWtO property ONLY.
Any construction on the public domain (Curbs, sidewalks, drivewoyn,
ruarquees, etc.) Will Moira Mamie permission'
Plan Check No ...........
. BUILDING,'41L "001/1
PLUMBING
BEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
F;VI�VD)�JOVIUC
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 6-1107
Valuation I Fee
00 1(3
DID.
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-
lmowledged in space provided.
.1
FILE /9 E_.j
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