690050.pdfNAME (OR NAMM OF I
CAVY
A M -el
a
CITY
NAME
M
Applicant FIR
Inside Heavy Lines
/9?
0 GAS
RESIDENTLA LINE
El NEW F�
NoN_REsrDI TIAL SIGN
RETAIMNG
rK DEMOLISH EJ WALL
E] ALTER K_r EXCAVATE FENCE
0 OR FILL ( ........ . x .......... Ft.)
REPAIR PRE -MOVE swim
El INSP. NUMBER OF POOL
DWELLING
UNITS
t
N
I
I hereby acknowledge that I have read this application; that the In-
formation given to 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 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
rela.Ung to Workmen's Compensation Insurance.
NOTE: Permit Mmit One Year (Except DE51OLITIONS which
shall be Completed in ninety days: MOVED -IN BUILDINGS shall be com-
pleted in mix months.)
NOTE: Applicant Subject to Plan Check Fee
Thin Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, drlvtwav$,
marquees, etc.) will require separate parmisslon.
P NO.:
N
_6�_
PERMIT
NUMBER
A.4e W&
EXISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ........ ... FT.
OF
[] YES [3 NO
Man Check No ...........
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
[] YES
DEFICIENCY THIS PROPERTY
[] YES [3 NO
Fee
P&
Z
F4
No.
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or Ids Dep-
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
D�ATx
EDMONDS
PR 6-1107
.a
FILE
I
"V4
Illy
RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
(Rough)
Frame
Furnace & Fuel Lines -
Final
RECORD OF INSPECTIONS
Date Passed
Drainage
Sewer
Parking
Landscaping
Fire.Dept. b