690214.pdfa I
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
04 *-^1
3
//7 X-7
CITY I TEEff FON—ENUMBLR
V, 0-3 Av�wfr 27LIi—
WAM113:,
I
C I .
P N PERMIT
NUMBER 690214
EXISTING STREET R/W
COUP. PLAN ST. R/W ............ rr-
13 YES 13 NO
DEFICIENCY THIS PROPERTY
43,
,;NAME
t- L 0 of yj
ADDRMSS
CHECICTE BY
TY TELEPHONE NUMBER
&A
ill LICENSE NUMBER ITT LICENSE N HER
Legal Description Of Property (Show Below or Attach Four Copies)
METER SIZE SERVICE SIZE
CLEARANCE
CHECKED BY
19
REMARKS
TYPE CONNECTION VERIFIED By
PERO. TEST
PERMIT NUMBER
REMARKS
FIRE ZONE TYPE 03P CONSTRUCTION STREET IMPROVED
.1
13 YES 13 NO
SPECIAL INSPECTOR REQUIRED
[j YES 13 NO
OCCUPANCY GROUP
GAS
RESIDENTIAL LINE
El NEW
NON-RESIDENTIAL SIGN
1:1 �" RETAINING
DEMOLISH WALL
ALTER EXCAVATE PENCE
OR FILL ......... x . ........ rt.)
PLAN CHECKED BY
REMARKS
REPAIR PRE -MOVE SWIM
INSP. POOL
El- El
94u"Min 0
DWELLING
"ITS
NATURE OF WORK TO
XBEO
Valuation
Fee
Receipt No.
z
0
Plan Check No ............. ......
PROPOSED USE
BUILDING
PLUMBING
91
PLOT PLAN (Indicate Building setbacks, abutting streets)
0
HEAT & GAS LINE
FENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OIL FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this Application; that the In-
form&Uon given to correctj and that I am the owner, or the duly
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
ATTENTION
THISPERMIT
APPLICATION APPROVAL
This application is not a permit until
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Your (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be OOm-
AUTHORIZES
ONLY THE
WORK NOTED
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
plated in six months.)
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
d_q
RE (OWNER OR AGE7T) DATE BI NED
—DLRECTOWS 01ONAT
DAW
NOTE: Applicant Subject to Plan Check Fee
PH 6-Im
4
This permit coven work to be done On private property ONLY.
Any consgruction an the public domain (curbst sidewalks$ drivewILYst
marquess, "a.) Will require separme permission.
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