680025.pdfBUILDING DEPARTMENT Applicant I=
Inside Heavy Lines
PERMIT APPLICATION
NAUM (OR NAME OF BUSINESS)
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F-1 ALTER
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VdAlft V-4-0225
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TELIOPHC
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UM—BER CITY Lac
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Property (show Below or Attach
RESIDENTIAL
I
[:]
ZAE
NE
NON-RESIDENVIALI
F-1
SIGN
DEMOLISH
RETA1NING
WALL
EXCAVATE
OR FILL
FENCE
PRE -MOVE
INSP.
SWIM
POOL
e-0 �;M
40
N:
DWELLING
UNITS
136-
.43s�
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V
U3 Ott,
I hereby acknowledge that I have read this application; Una the In-
formation Oven Is correct: and Mat I am the owner, or the duty author-
Ised 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 Workmen's Compensation Insurance.
NOTE: Permit Limit Orie Year (Except DEMOZATION8 which
shall be completed In ninety days; MOVED -IN BUILDINGS shalt be onto.
pleted In six months.)
IVOTE: Applicant Subject t4.Plan Cbeck Fee
This Permilt cove" work to be done On private property ONLy-
Any to , ctlon on the pubtlo domain (curb$, alfiewallits, driveways,
marquees, etc.) will require separate permission.
-6-0-
PERMIT
NUMBER i onr
[3 TEO
0 NO
'W
STREET R/W . eo FT. DEFICIENCY THIS PROPERTY
77
ICK
0
REMARKS
0110u� 13Y
4 D-
METER SIZE SERVICE PME
CLEARANCE
CHZCKr.D 13Y
REMARKS
VEBWED BY
TYPE CONNECTION
UMBER
TEST
REMARKS
FIRE TYPE OF ON STREET IMPROVED
13 YEB NO
s.
N
)CCUPANCY GROUP
[3 YES *NO
ALAN CHECKED 13
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Information on trusses to be supplied before
installation. All
construction to conform
111-i+j, Tma iqQ-
Valuation Fee Receipt No.
t
PlAn Che*
BUILDING
PLUN39NG
BEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
UE
ATTEDMON APPLICATION APPROVAL
TWO PERMIT Tbla application is not a pernilt until
AUTHOUT7.rA
ONLY THE signed by the Building Official or his Dep-
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged In space provided. I
INSPECTION
DEPART11ENT
clury OF
EDMONDS
PR 6-1167
rum 41
I
west I
said i
cellte')
tw ft
V031
RECORD OF INS DECTIONS
Date Passed
Foundation
P lumbing (Partial)
(Rough)
Frame
Furnace & Fuel U . ne
S-
Final