690041.pdfBUILDING
_90'STED ON IMOLL MAP NO.:
PERMIT
1 NUMBER 690041
DEPARTMENT
Applicant Fill
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PERMIT
APPLICATION
Inside Heavy LtIlnes
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(OR NAME OF BUSINESS)
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NAME
ADDRESS
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CITY
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ADDRESS
CITY
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--U—SE] ENE LOT AREA VACANT SITE
6 � I ;)- I I_P� YES 13 NO
UPMUT I BUILDING AREA iVARIANOM NUhWEkC
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; STREET R/W i�Ze..FT. DEFICIENCY THIS PROPERTY
PLAN ST. It 1W -S..- XT. ..... 4P ... In.
indicated on Standard
7
TELEPHONE NUMBER
METER S1
CITY LICENSE NUMBE-61t. --71-
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or Attach Four Copies)
A __1 I GAS
NEW RESIDENTIAL LINE
1� 1:1 NON-RESIDENTIAL SIGN
DADD 1= RETAINING
ElDEMOLISH WALL
0 ALTER EXCAVATE FENCE
1-1 OR FULL D ( ........ . X ......... Ft.)
REPAIR PRE -MOVE swim
1:1 INSP. POOL
rUMBER OF STORIES NUMBER or
DWELLING
UNITS
[3 YES
A., F 6 7/?
ePlan
Check No .................
PROPOSED USE
Q
BUILDING
PLOT PLAN (Indicate Building setbacid, an streets)
PLUMBING
HEAT & GAS ZANE
10
FENCE
Q,
SIGN
RETAINING WALL
SWIMMING POOL
70
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this 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-
ATTENTION
lating construction; and In doing the work authorized thereby, no peruon
will be employed in violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmens Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE31OLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be oom-
pleted in mix months.)
SIGNATURE �9W!J�R AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Appli"nt Subject to Plan Chcck Fce
PR 6.1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs# sidewalks# driveways,
marquees, etc.) will require separate permission.
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YES [I NO
Valuation I Fee
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No.
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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-
knowledged in space provided.
I C�' �
Paz
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