690141.pdfIs
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-.,BUILDING DEPARTMENT
P' PERMIT APPLICATION
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MAILING ADDRESS
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Applicant Fill
Inside Heavy Lines
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HONE NUMBER
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WLI(IIIINSE NUM13ER CITY LICENSE NUMBER
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,Description. of Property (snow/i3inow or Attach Four Copies)
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GAS
IIIINTIAL L..
EW [D�RE NE
'NTIAL
El NON -RESIDE IGN
A ICETAIMNG
0 DEMOLISH WALL
DALTER EXCAVATE PENCE
n OR FILL I .......... x .......... Ft.)
REPAIR PRE -MOVE swim
n INSP. POOL
iUMBER OF STORIE: NUMBER OF
DWELLING
UNITS D t-A C
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I hereby acknowledge that I have read this application; that the In-
formation given Is correct; and that I ara the owner, or the duly author-
ized agent of the owner. I agree to comply vIth 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.
ermit Limit One Year (Except DEMOLITIONS which
�Tb��C!�npleted In ninety day"; M0VED-XN BUILDINGS shall be com-
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NOTE: Applicant Snbject to Plan Check Fee
_iWe Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs. sidewalks, driveways.
marquees, etc.) will require separate permission.
L MAP NO.:
5- - '7
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PERMIT
NUMBER b
TBACK RNAlt X
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qL VACANT
I rl YES
Mom
BACK
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_,OT PI71AN
.,REBT IW-W
XISTINd_ STREET R/W ........ .. . FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ IT. . .......... -ITT.
PWMARKS
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CHECKED BY
LETER SIZE SERVICE SIZE CLEARANCE CHECKED BY
ZMARKS
'YPE CONNECTION VERIFIED BY
-ERC. TEST PERMIT NUMBER
tEMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROV
[] YES [3 NO
;PECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
] YES 13 NO I I
�LAN CHECKED B)D
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Valuation
Plan Check No ............
BUILDING
PLUMBING
HEAT & GA13 LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCkVATION OR FILL
Fee
No.
TOTAL AMOUNT DUE
A!r=l%MON APPLICATION APPROVAL -
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
Fn 6-1107
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