690286.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
(OR NAME OF BUSINESS)
F:.- H FS
MA1105 ADDRESS
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z
N
0 Iq Alf �,/y
1�1 NEW
0 ADD
1:1 ALTER
E] REPAIR
N
/V
Applicant Fill
Inside HeavY Lines
- ;2- PP-
U C_
I [—� GAS
RESIDENTIAL LINE
NoN-RESIDENTIALJ D SIGN
RETAINING
DDEMOLISH WALL
FEXCAVATE FENCE
OR FILL ( ........ . x .......... Ft.)
PRE -MOVE SWIM
INSP. POOL
DWELLING
UNITS
7
)LL WAP NO.: PERMIT
NUMBER 690286
MACK I STREET BETISAU An YARD SETBA
K , I BE
=81rG*';;RE1ET R/W A��-
COUP. PLAN ST. n),w S.- rr.
a-x� Cl NO
DEFICIENCY THIS PROPERTY
indicated on Standard Drawing #103.
Im
[3 No
13 YES
F�
Plan Check No ............ . .......
BUILDING
PLUMBING
HEAT & GAS LINE
streets)
tRETAINING
N
FENCE
SIGN
I
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
MCCAVATION OR FILL
I hereby acknowledge that I have read this application; that the In-
formation given In correct; and that I am the owner, or the duly author-
tzed 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 Coda of the State of Washington
relating to Workmen's Compensation Luu=ca-
NOTE: permit Limit One Your (Except DEMOLITIONS which
shall be completed In ninety days: MOVED_XN BUILDINGS shalt be com-
plated In mix months.)
X_� 17
NOTE: Applicant Subject to Plan Check Fee
_jgs —permll covers work to be done = Private PrOPuty ONLY -
Any Construction 00 the Public danu" (curbs, aldewalki, driveways,
marquees, at&) will require sapgrSte PeCT01251an-,
TOTAL AMOUNT DUE
1�
11�
ATTENTION 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 DIRECT SIGN01k
DEPARTMENT :
CITY OF DA
EDMONDS
PH 41-1107 L�L
d
Fife' Dep.t.'.