690429.pdf0 .
1;
d
C
IU-ILDING DEPARTMENT
PERMIT APPLICATION
or
Applicant Fill
Inside Heavy Lines
GAS
NEW RESIDENTIAL LINE
NON-13MIDENTZAL F-1 ......
I
ADD RETAINING
WALL
17
DEMOLISH
E] ALTER EXCAVATE PENCE
n OR FILL ( x Ft.)
......... . ........
REPAIR PRE -MOVE SWIM
n INSP. POOL
DWELLING
UNITS
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-
Ized agent of the owner. I agree to comply with city and state laws regu-
tailing 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 WorkmeWs Compensation Insurance.
NOTE: Permit Umit One Your (Excep LITIONS which
shall be completed In ninety days; MOVEDAN
DletedJjl six months.) /7 ?WILD 7 shall be com.
NOTE: Applicant Subject to Plan Check Fee
This permit coven work to be done on private property ONLY.
Any oonstruction on the public domain (curb@, sidewalks, driveways,
numquees, etc.) will reQuIre separate permission.
C
P N
EXISTING STREET n/W .......... XT.
COMP. PLAN ST. RAV ........... XT-
[3 YES 13 NO
Plan Check No ............
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION. OR FILL
TOTAL AMOUNT DUE
ATTENTION
THISPERMT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PIEL 6-1107
PERMIT
NUMBER
b7u
RAC
I REAR YARD
VACANT SITE
AN ::1:3
No
13 YES :::
V NOE NUMBER
DEFICIENCY THIS PROPERTY
[] YES 13 NO
Valuation
I
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
,j7�
Lv 'A�
I llt� d 1, �p
1pn'�
In
0 1 1 1
t9
I P
I p
4 'r
I A 1, —
I d
dd
...........
p e,
0 d
dd
%fo
I
6 RECORD OF INSPECTIONS: — d L I'
40
Appl. No . ................... . .... 1.
Permit limit, one year
hereby Mad
is e for a permit to construct the following work, in accordance with the accom,
sp, I ecifications. Two am are submitted herewith for approval.
aiter Off'st.
ir............... ................................................ Parking ..... . .. . ........... .
.. ........
Zone
..... Fire ...........................
. ............... Const. type ................................ Use zone ...... ......
......... lk ............. Addn ........
..................... .......... Septic tank .................................................... . ...
e . ............. 9:-> ....... Arm ..........
dp . .............
front ............ . ......... r. si ................ 1. side .............................. rear ...............................
........... Address. .... .............. . .............. Tel. No .............................
Address. ................................................... Tel. No .............................
1-,:Bui1der ...................................................................
..... Address .................................................... Tel. No .............................
'�Plans� by .. .........................................................
ks .............................................................
Remar .� ............................................................ .......................................................
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work!
S ed Owner/Agentt::� . ..............
Address-46
Ign xe ..................... �rl-f .....
PERMIT for the above work is hereby, approved, subject to the above conditions, and to compliance with the ap,
p . rove I d plans and specifications, and Building Department notations thereon.
Z'6 e ........................
Valuation ................................... Permit fe .......
Recd. by .....
x/ — 0 ......... .........
Building Department, By .... ...... Date ........ ....................
IWECTION RECORD
Fdn, OK ............................................ Frame, oK .................................................... Final, OK .......................................
This Permit does not cover Plumbing, Sewer or Electrical installations.
0