700134.pdft
6
E.
)STED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT AppUrant Fill NUMB
PERMIT APPLICATION Inside Heavy Lines jCB ADDRESS
I NAME (OR NAME Ubw BUSINESS) I .) � / / /I/) — tv 1� PA, - exi
onstruc
attached
NEW
RESIDENTIAL
__1
GAS
LINE
N ON -RESIDENTIAL
SIGN
RETAINING
WALL
DEMOLISH
E] ALTER
EXCAVATE
FENCE
OR FILL
( .......... x . ........ Irt.)
REPAIR
PRE -MOVE
INSP.
El-
swim
POOL
iUMBER OF STORIES
l N4UUMBW. OF
DWELLING
UNITS
AnDroximately 1s000 cubic
see attacheds
V4
700134
[] YES 13 NO
STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
LAN ST. R/W ............ FT. ............ IT.
FIRE ZONE TYPE OF CONSTRUCTION I 13TREET IMPROVED
[3 YES 13 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
[3 YES 13 NO
PT.AN V.RRV�KV.n TIY
REMARKS
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
I EXCAVATION OR FILL
r TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given is 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- ATTENTION
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 THIS PERMIT
relating to Workmen's Compensation Imuranoe. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.) _t INSPECTION
FIC:iNAT RE (OWVrjE!j OR AGEA) DAWN LON D DEPARTMENT
CITY OF
�' 77 0
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This Permit covers work to be done on. private property ONLY.
Any construction On the public domain (curbs, sidewalks. drIV&WXYD,
marquees, ate.) win require separate permlislon.
Fee
I / 0
pt 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.
,,1-3-70
FILE
I