680256.pdfF
BUILDING DEPARTMENT Applicant Fin
PERMIT APPLICATION Inside Heavy "Anes
PERMIT
NUMBER
USE ZONE T AREA VACANT Orria
NUMBER 13 YES NO
I VARIANCE NUMBER lk
OA�.. ./ �
1r%lfHPHDNE NUMBER EXISTING STREET R/W DEFICIENCY THIS PROPERTY
COMP. P
REMARKS
CRED BY
"k-UONE NUMBER
) . METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
CENSE NUMBER LICENSE NUMBIGA
6 C/o REMARKS
irintlon of ProPert r Copies)
11 A, I-
t PERO. TEST PERMIT NUMBER
RESIDENTIAL
i GAS
M LINE
NEW
1
NON-RESIDENTIAL
F2 �SIGN
RETAINING
�Ww
0
DEMOLISH
F1
WALL
ALTER
EXCAVATE
OR FILL
FENCE
El ( ........ . X . ........ Ft.)
REPAIR
PRE -MOVE
INSP.
SWIM
1:1 POOL
NUMBER OF
DWELLING
UNITS
FIRE ZONE TYPE OF CONSTRUCTION STBZET 1UPROVJ
I I [] YES 0 No
[] YES [3 NO
Plan Check No .....................
PROPOSED USE
BUILDING
PLOT PLAN (indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
12
a
PENCE
t
SIGN C3
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby eAknowledge 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 agres to comply with city and state laws regu-
wA in doing the Work authorized thereby, no person
ATTENTION
lating construction;
will be employed In violation of the Labor Code of the state Of Washington
relating to WorkmeWs Compensation Insurance.
NOTE: Permit Limit One Your (Except DEMOLITIONS which
&hall be completed In ninety days; MOVED -IN BUILDINGS Rhall be 0002-
THIS PERMIT
AUTHORIZFS
ONLY THE
WORK NOTED
plated In six months.) —
RE =(OWNER 0 ENT) DATE ONE
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan dech Fee
PH 6-1107
Two--pemd, covers work to be done 099 private properly u'4�z-
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, f4c.) WIu require separate permlosloo.
Valuation
0_�L
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.
IR � r/
FILM 44.
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RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
(Rough)
Frame
Furnace & Fuel Lines_
Final
RECORD OF INSPECTIONS
ed
Date,Pass
Drainagd
Sewer ---
Parking
Landscaping
Fire Dept.
9