700015.pdfa
BUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
13A e iz+ Irc-J
MAILING ADDREBS
CITY T
Applicant Fill
Inside Heavy Lines
9— 41)9/r
PERMIT
NUMBER
0 YES 13 NO
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ADDRESS
A1.911 /0�37 kholli gt�
STREET H/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R1W ........... XT. ............ 17.
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TELEPHONE NUMBER
REMARKS
NAME
wa Jeovi r" R C—A
CHECKED BY
CITY
'1.41ws
TELEPHONI-3 NUMBER
METER SIZE SERVICE SIZE I CLEARANCE
I n1qFrjCPn JAY
A
K
iciow or Attu= k'our Cog
5;'* 121 h
RESIDENTIAL GAS
E] NEW -!rl I El LINE
NON D SIGN
PErADD RETAINING
DEMOLISH WALL
ALTER EX(3jLVAThl PENCE
OR FILL 0 ( x Ft.)
REPAIR PRE -MOVE SWIM
INSP. POOL
NUMBER FF
DWELLING
UNITS
%_ uy-;/. 'oneAl
El YES
TYPE OF
MW
Plan Check No ............
BUILDING
PLUMBING
BEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application: that the In-
formation given In correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state law regu-
lating construction; and In doing the work authorized thereby, nonperson
ATTENTION
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DFHOLITIONS which
ONLY TRE
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
WORK NOTED
pleted In six months.)
319KRFURE (OWNE14,OR AGENa.)L,_ . j
DATE
INSPECTION
DEPARTMENT
CITY OF
IL
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
—
Pn 8-1107
This Permit covers work to be done on private property ONLY.
Any construction on the Public domain (curb@, sidewalks, driveways,
numqueeso etcJ will require separate permission,
Valuation
(D
STREET IMPROV]
[] YES 0 NO
PC4&0.j .
Fee
0
�%o
I Ise �0
APPLICATION APPROVAL
This application Is not a permit until
signed by Uie Building Off Icial or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
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