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BUILDING DEPARTMENT Appucant m
PERMIT APPLICATION Info Heavy unes
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NAME
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TELEPHONE NUMBER
NAME
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CITY
QAVOC"ASE
AMIMMONE NUMBER
NUMBER
ClTr LICENSE N Ul_�R
02 57
Legal Description or Property (Show Below or Attach Four Copies)
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GAS
NEW RESIDENTIAL LINE
N -Rr
ON MDENTIAL SIGN
RETAINING
DEMOIJOR WALL
ALTER EXCAVATE FENCE
OR FILL . ........ Ft.)
REPAIR PRE -MOVE swim
INSP. POOL
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UNITS
1"ELL" 71.)
NATURE OF WORK To BE L)ONE
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KISTING STREET R/W
COUP. PLAN ST. R/W
178
en
ING Al
Yr AREA —VA-5ART SITE
13 YES 0 NO_
DIMCIENCT TIUS PROPERTY
those indicated on Standard
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[3 YES
Plan Check
PROPOSED USE
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BUIMING
PLUMBING
PLOT PLAN (IndlCRt8 Building "tZaCK0, abutting streets)
HEAT & GAS LINE
PENCE
SIGN
N
RETAINING WALL
SWIMMING POOL
UJ
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby aanowledge that I have read this application; tbat 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 rogu-
ATTENTION
I&tlng construction; &W In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
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relating to Workmens ComPcn"ti0n Inmiranoe.
AUTHORIM
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; movr.D-xN nuummos shall be oom-
plated in six months.)
INSPECTION
11ONATURE (OWNER OR AGENT)
DATE SIGNE
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
_igs Perud, coven work to be done on prlvMa property ONLY.
Any construction an the public domain (curbs, sidewalks, drivMars,
marquess, c4c.) will require separate permission.
Valuation
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13 T30 0416'_
Fee
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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-
linowledged in space provided.
7
Building Permit Number 680178�
At �tt, 1111all � 111:1 11 1:1, i�
i Occupancy established by this certificate: No. Stories
t
Fire Zone
ijartment. Basement NO
22 Unit Ap Type Const. V
signs posted (per Sec- 3 3 01 (i) U.B.C.)
Floor Load signs in place (per Sec. 2308 U-B-C') —. Capacity
Floor load and -roam CaPacitY signs, when required, must remain posted at all times.
THE HAS BEEN INSPECTED AND APPROVED AS COMPLYING WITH
tOVISIONS OF THE EDMONDS BUILDING CODE AND WITH UNIFORM BUILDING CODES.
Issued I this day of Mmy 19 74
CHIEF BUILDING OFFICIAL BY
'public area and shall not be removed, mutilated or obscured and shall be main -
This certificate shall be posted in a conspicuous cupancy requires a new certificate.
tained in legible condition at all times. Any change of oc
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