680202.pdfF
NG DEPARTMENT
IT APPLICATION
Applicant F111
Inside Heavy Lines
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PERMIT
NUMBER
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680202
E3 YES [:) NO
ML�MK n/W
EXISTING STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... 1". ..0 ...... 1". —
indicated on Standard Drawing 0103.
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NEW Is RESIDENTIAL
EjNON-RESIDENTrAL
ADD in
DEMOLISH
ALTER EXCAVATE
on FILL
1:3
GAS
LINE
SIGN
RETAINING
WALL
PENCE
rt.)
[3 YES [3 NO
PLAN CHECKED BY
REMARKS
REPAIR PRE -MOVE
INSP.
SWIM
POOL
NUMBER or
DWELLING
UNITS
TATURE OF WORK TO BE D��E,
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Plan Check No ............
PROPOSED UBE BUILDING
PLOT PLA14 (indicate Building setbacks, &butting streets) PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
A�, LLt PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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 agree to cc.mply with city and state laws regu- ATTENTION
lating construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code Of the Slats of Washington THIS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Your (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVEo-IN BUILDINGS shall be oom-
pleted In six TOO INSPECTION
I NATU 0 ER ORA T) DATIR�10*ED DEPARTMENT
lzopzlz`�_ CITY OF
E12a EDMONDS
NOTE: Applicant Su6v'to Plan Check Fee PR 6-1107
his permit coven work to be done on private property ONLY.
Any construction an the public domaln (eOrbS, Sidewalks, drIVOWAYS,
nuwqueog, etc.) will require separate 9w=155100-
-3
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0 YES 0 No
No.
1-6-1
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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-
Imowledged in space provided.
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IONS
L RECORD OF INSPECT
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Mte Passed
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Foundation 20
ILI 111 .0
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(Rough) 0
Plumbing (Partial) j 4
Frame 4
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Furnace & Fuel Lines.
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