690435.pdfx
9
BUILDING DEPARTMENT Applicant EM
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF Btlql�4ESS)
a 4E �_ T ff,6�11PIZ5:_
MAIIJNG ADDRESS
?(2-- 140 r//1
CITY TZ_LEPH9NE NUMBER
17A
W/f/ 4 V 7 Ixy—
NAMIG
06-0 "e�feljl
Fei_ r /-/ alff F, -
I,
01
NEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
0
SIGN
ADD
RETAINING
DDEMOLJSH
WALL
EXCAVATE
FENCE
ALTER
OR FILL
x Ft.)
REPAIR
El
PRE -MOVE
El
......... . ........
SWLM
POOL
INSP.
iUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
F
�/,!g
lg7rIIACI
I
PERMIT
NUMBER
TW
%..�
FBACK
f
I
150po /
No
EXISTING STREET R/W Aetla.FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W.4.0..XT. ... 0 .... in.
REMARKS
on Standard Drawing No. 103.
514 it 1 31 q- I a
,5" /=— CA-' /—=— PIZ
No
[] YES &<O�
8A 51C. P660 SANC AS'
4(S-/
96 4
Plan Check No ............. ... ...
BUILDING
PLUMBING
2g streets) HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
In
I hereby acknowledge that I have read this application; that the In-
I t th a
formation given is correct; and that I am the owner, or the duly author-
y an Ih
Ized agent of the owner. I agree to comply with city and state laws regu-
"we to
ATTENTION
no person
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
'"hington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Your (Except DEMOLITIONS which
r]
ONLY THE
WORK NOTED
I be cm_
shall be completed to ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
ED
31ONATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
P—H
DEPA RTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit coven work to be done an private property ONLY.
Any construction on the public domain (curb$# sidewalksp driverwaypp
maNuftst etc.) will require separate permission,
Valuation
Fee
0
2
No.
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.
WArr"014
�Wl I
7 7 -
..........
Af4,00,
If
RECORD OF, INSPECTION
Date Passed
Foundation
Plumbing (Partial)
(Rough)
Frame
''.Furnace & Fuel Line
Final -76
IT
RECORD OF INSPECTIONS`.
Date Passed
Drainage
Sewer
Parking
Landscaping
Fire Depti
I
a