690054.pdf----------
BUILDING DEPARTMENT
PERMIT APPLICATION
NAM (OR NAM 13U A
OF
UAILING ADDRESS
-2/ 7
CITY
oAjds�
NAME
Y
1A )DRESS
Applicant FW
Inside Heavy Lines
TELEPHO!
TOO 8
IUMBER
)/ b
CITY TELEPHONE NUMBER
NAME
ADDRESS
J4 W
CITY TELEPHONE NUMBER
STXTE LICENS9 NUMBER CITY LICENSE NUMBN
I Legal DescriDtion of Property (Show Belom or Attach Four Copies)
RESIDENTIAL
NEW
I
GAS
LINE
E] NON-RESIDENTIA'L
F I
SIGN
ElADD
nDEMOLISH
RETAINING
WALL
ALTER EXCAVATE
OR FILL
PENCE
( ........ . x ..........
PRE -MOVE
REPAIR F-1 INSP.
swim
POOL
DWELLING
UNITS
PROPOSED USE
PLOT PLAN (Indicate Building setbacks, abutting streets)
b/o Ll 5 N
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-
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 DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In nIx mqnths.)
� NOTE: Applicant Subject to Plan Check Fee
TIls permit covers work to be done on private property ONLY.
Amy construction on the public domain (curbs, sidewalks, driveways.
marquees, ate.) will require separate permission.
,P No.:
5-a I —
SETBACK I STR
PERMIT
NUMBER 6900554
-_W-J
13 YES 13 N
I nTTILDINCI AREA� I VARIANCE 14UMBE
PLOT PLAN APPROVED
STREET R/W
EXISTING STREET R/W ........... XT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............. 77. ........... 11T.
REUARKB
ICHECKED BY
METER SIZE I SERVICE SIZE I CLEARANCE CHECKED BY
REMARKS
TYPE CONNECTION VERIFIED BY
0
Z
144
Z
PERC. TEST PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
[3 YES 0 NO I I
PLAN CHECKED BY
Plan Check No ............
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
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
CliTy OF
EDMONDS
Pit 6-1107
C) J
Fee
No.
I -A. 0 b K 4- 99,0
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building official or ills Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
F�
I
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