680542.pdfBUILDING DEPARTMENT
Applicant F111
PERMIT APPLICATION
Inside Heavy Lines
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NAME (OR NAME OF USINESS)
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MAILING ADDRESS
M309 4,CAL�a_r
CITY
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TELEPHONE NUMBER
NAME
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ADDuEua
AbI174601,0W
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CITY
TELEPHONE NUMBER
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NAME
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ADDRESS 1-2 L 19, 51 'L
CITY
TELEPHONE NUMBER
STATE LICENSE NUMBER
CITY LICENSE NUMBER
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Legal Description of Property (Show Below or Att Mch Fout Copies)
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7
GAS
ElNEW 12KRESIDENTIAL LINE
I NON-RESIDENTIAL SIGN
ADD RETAINING
MDEMOLISH WALL
EJALTER EXCAVATE FENCE
M on PILL ( Ft.)
........ �x ..........
PRE-mOVE swim
1:1
REPAIR
D INSP. 1:1 POOL
NUMBER OF STOIUE13
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
PROPOSED USE
PLOT PLAN (Indicate Building etbacks, abutting streets)
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I hereby acknowledge Mat I have read We application; that the In.
formation given is correct; and that I am the Owner, or the duly author-
lzed 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 One Year (Except DE51OLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
SIGNJ7 (OV
,V4ER AGENT)
a.i 11
a-a_� L Y
DATE SIGNED
I � /-?
NOTE: Applicant Subject to Plan Check Fee
This Pemilt coven work to be done on Private Property ONLY.
Any bonstraction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate Permission.
PERMIT
NUMBER
RD SET�ACK STREET E
I Tn t� ,� 5 1
VACANT SITE
13 YE13 "0
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TREE / �-v
:XISTING STREET R/W .......... FT. DEFICIENCY TIUS PROPERTY
COMP. PLAN ST. R/W ........... XT. ... .... I ... M.
-1 YES
Plan Check No ........
BUILDING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
Valuation
[] YES
Fee
APPLICATION APPROVAL
7
No.
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.
NEON
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I
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RECORa OF INSPECTIONS
Date PasseA
Foundation
Plumbing (Partial)
(Rough) �? u —
Frame
Furnace & F uel Line
Final
'RECORD OF INSPECTIONS
Date Passed
'Drainage
Sewer
Parking
Landscaping
Fire Dept.
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