690418.pdfI
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BUILDING DEPARTMENT Applicant F111
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PERMIT APPLICATION Inside Heavy Lines —jCB ADDI
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MAILING ADDRESS
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NAME
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LICENSE NUMBER CITY LICENSE NU—MB]
)escrlPtion of Property (Show Below or Attach Four Copies)
NEW
IN RESIDENTIAL
GAS
LINE
ADD
LEI.,
NON-RESIDENTIAL
SIGN
ElDEMOLISH
RETAINING
WALL
ElALTER
EXCAVATE
PENCE
1:1
OR FILL
PRE -MOVE
( ........ . x Ft.)
SWIM
REPAIR
F1
INSP.
POOL
�UMJJER OF STORIES
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Nuilff L�Ror
DWELLING
UNITS
fn,0yV.
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.
seed 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 Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
Pleted In six months.) J
P NO.:
I I I EW VA r—_—p
EXISTING STREET R/W ............ FT.
COUP. PLAN ST. R/W ............ FT.
0 YES
NO
or
PER1IIT
NUMBER
6904 016'
VACANT SITE
El YES [a NO
VARIANCE NUMBER
DEFICIENCY THIS PROPERTY
............ FT.
7�umlolrz: g6cr—
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Valuation
13 YES 0 NO
Fee
Plan Check No ............ . .......
BUILDING
PLUMBING
EE AT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMIUNG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
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This application is not a permit until
AUTHORIZES
ONLY TJIE
signed by the Building Official or his Dep-
WORH NOTED
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
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NOTE: Aj)plicant Stibject to Plats Chech. Fce
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbm, sidewalks, drivewRys,
marquees, etc.) will require separate permission.
INSPECTION DIRECTOR'S EIIONATR41�
DEPARTMENT
CITY OF
EDMONDS
PH 8-1107
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RECORD OF INSPECTIONS
Date Passed
3,o� 47%r
Foundation
Plumbing (Partial)
(Rough)
Frame AP
#7� �70
Furnace & Fuel Lines AJO L
07000z?4 �W v
Final
RECORD OF INSPECTIONS
Date Passed
Drainage
Sewer
Parking
Landscaping
Fire Depto
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