690147.pdfit
3
BUILDING DEPARTMENI
PERMIT APPLICATION
NAME; con'""s or P& TN=B)
ea. C' tj2 iz-Sto,
1Z J �2 I - 7 2t41
or
Applicant 11111
Inside Heavy Lines
NEW
HaRESIDENTLILL
GAS
LINE
1:1
NON-RESIDENTIAL
SIGN
RETAINING
K:h�
DEMOLISH
WALL
ALTER
EXCAVATE
OR FILT
PENCE
x-. Ft.)
.........
REPAIR
PRE
INS��Ovm
:NML
DWELLING
utme
,ZATURE I WORK TO
N
a
- �
%
[3 YEB
P NO.:
PERMIT
NUMBER
�7
D_ �
690147
rE Urr AREA VACAMXT OITEE
13 TES 640�
NUMBE]
32UILMING AREA Tyj�os` _716
VIROV95--
Jr/W or -
; STREW R/W ....... JFT- DEPIC=Cy TIM PROPERTY
Plan Chock'No .............
BUILDING
_�Uttlng streetw)
Pj.U3U3rNG
HEAT & GAS LINE
PENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EOCCAVATION 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-
ized agent of the owner. I agree to comply with city and state laws r*gu-
ATTENTION
I&tlng construction; and in doing the work authorized thereby, no person
win be employed in violation of the Labor Code of the State of Washington
THM PERMIT
relating to Workinen's Compensation Insurance.
AUTHORIZES
ONLY TM
NOTE: Permit Umit One Year (Except DEMOLITIONS which
WORK NOTED
SWI be completed In niD84 days; MoVFJi_IN BUILDINGS shoal be com-
pleted in six mont".
81 ATIJRM (0 LER_ OR �tPNT) IJAWIW SIGNJAP
.
//-,9
INSPECTION
DEPARTMENT
/11
—,
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This permit coven work to be done col private property ONLY -
Any Coustruction on the public domain (curbs, sidewalks, driveways,
marquees, ek.) Will require SOPSM90 permission-
C3 YIES
Valuation I Fee
00
I S_. 0 0 1 q-q tel
APPLICATION APPROVAL
TWs application Is not a pern-At until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt to ac-
knowledged in space provided.
i