670416.pdf4
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATinN Inside Heavy Lines
NAME (OR NAME OF BU7.ESS) . E? /7-7 j
1!2�e P? cp r
MAILING ADDRES0
TELEP FNE NUMBY69
NAME
. NEW
RESIDENTL
GAS
LINE
NON-RESIDI TIAL
SIGN
ADD
ElDEMOLISH
RETAINING
WALL
0 ALTER
R
EXCAVATE
OR FILL
PENCE
( .......... x ..... .... Ft
REPAIR
El
PRE -MOVE
INSP.
swim
POOL
Es
NUMBER OF
�2_
DWELLING
UNITS
NATURE F WORK TO BE. 1?0
:Vcu A* /6 7/
/
J71
7'
60 L
be^,
d, rV6
(I I I
NO.: PERMIT
NUMBER 67 0416
131DE YARD SETBACK I STREET SETBACK REAR YARD bNXISAVA
EXISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ FT.
1 _:ZE7
SPECIAL INSPECTOR REQUIRE
El YES ARKO
PLAN CHECKED PY
-1 MMARK
& -A D�A
Plan Check NO ............
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
t
SIGN
N
RETAINING WALL
SWIMMING 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 that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws regU-
ATTENTION
latlng construction; and In doing the work allthorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THIS FER511T
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed In ninety days; I%IOVED-IN BUILDINGS shall be com-
pleted I� six months.)
BIG RE (OWNER GE T) DATE SIGNED
INSPECTION
DEPARTMENT
-(7CITY
OF
EDMONDS
NOTE: �AIPPlicant Subject to Plan Check Fee
PR 6.1107
This Permit covers work to be done on private property ONLY.
Any construction on the public donutla (curbs, sidewalks, drlvewaYs,
numquees, etc.) will require eepnrate permission.
0 YES
DEFICIENCY THIS PROPERTY
Valuation
E3 YES
Fee
"50
00
ISZ s-d
M
z
N
I
M
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-
Imowledged in space provided.
—qzl I— &P 11
FILE *q- F, .
I
" I