670493.pdf.5
kR_0_LL MAP NO.: PERMIT
Applicant Fill NUMBER
Inside Heavy Line JOB ADDRESS
1 17167 , --I
3J-q.�-
RESIDENTIAL
GAS
LINE
ElNEW
NON-RFMDENTIAL
SIGN
RETAINING
WALL
DEMOLISH
ALTER
n
EXCAVATE
OR FILL
NCE
7A_x_Jt ... Vt.)
REPAIR
PRE -MOVE
INSP.
EJ
swim
POOL
RUM—BER OF STORIES
NUMBER OF
DWELLING
UNITS
EXISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ FT.
0 YES 0 NO
Plan Check No ............
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31i0UNTDUE
I 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 Wee to Comply with City and State laws NgU-
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 PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Umit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months-)
3ioNATuRE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
0'
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This rermit coven work to be done on private Property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate Permission.
6-70493
0 YES
NO
MER
DEFICIENCY THIS PROPERTr
CHEMED BY
05L_
[] YES 13 NO
Fee I Receipt No.
I CZ , 0 t) R40 ) �
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.
FILE
I$
I
//.cA7
"APFLIGATIIIN�": BUILDING PONIT Appl. No . .................... ..... ......
r OF EDMONDS Bulkling Department Permit limit� one year
; "TION is hereby made for a permit to construct the following work, in accordance with the accom,
C;' , "..' -
�and specifications. Two sets are submitted herewith for approval.
Off'st.
Parking . ...........
----------------
o ................ Const. type .... Use zone ..... Z:nLd ........ Fire zone.....3 .. ........ . ...
OL
................... Lot ....... . 0 ......... BIA .................... Ad Kn=
r!k14 ... �-o ... o ................
..... Area ........... ............. o ............... ... Septic tank..
...... 0 ....... r. side .......... ?--/ ............ 1. side ............... .......... rear ...............................
17 :?A
,t� Addr .... . . Tel. No. -A ...... ........
A�.... ess.
Address.................................................... Tel. No .............................
Address................................................... Tel. No .............................
and State laws regulating this
Th6 is a correct statement, and I agree to comply with all applicable Codes
-Wor&
Date-/v-2.-1;:5r ....
gent.fvl�)� Address ............................................
Si ed Owner/A
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the ap
proved plans and specifications, and Building Department notations thereon.
A.. .....
Valuation ....... J.".0 .................. Permit fee .... :z.4 ............. Recd. by-_.
Building Department, By ............. ..................... . ................... Date ..... ........................
INSPECTION RECORD
Fdn, OK ............................................ Frame, OK .................................................... Final, OY . ........................................
This Permit does not cover Plumbing, Sewer or Electrical installations.
I