700153.pdfL
POSTEE
.411ILDING DEPARTMENT Applicant Fill
Inside Heavy Lines 7oH AD
PERMIT APPLICATION
NAME (OR NAME OF III as)
SIDE i
2 A/ /4
MAILING AI)DUN1111
USE
CITY
NAME
ADDRESS
-'I TELEPHONENUMBER
ITY
NAME
e)1-ijA.2 6446
ZI
ER
TELEPHONE NUMB
BE NUMBOR CITY LICENSE NUMBER
[on or Property (Show Below or Attach Four Copies)
r_1 GAS
NEW
RESIDENTIAL
L_j
LINE
I
1Z
NON-RESIDENTIAL
SIGN
D
RETAINING
WALL
ElDEMOLISH
1/2 ALTER
El
EXCAVATE
OR FILL
FENCE
( .......... x .......... Ft.)
REPAIR
F-1
PRE -MOVE
INSP.
r7
swim
POOL
DWELLING
UNITS
PC
I hereby acknowledge that I have read this 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 laws regu-
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
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DE31OLITIONN which
ahall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
M
NOTE: Applicant Subject to Plat; Check Fee
This Permit coven work to be done on privnte Property ONLY.
Any construction on the Public domain (curbs. sidewalks, driveways,
marquees, etc.) will require separate permission.
4f:
MOLL MAP NO.: PERMIT
NUMBER -7
1 to
7 �7 lt-tl P,, - &L-) -
3ETBACK STREET SETBACK JUWU�
LOT AREA VACA11
I I [] YES
I I
PLOT PLAN APPROVED
55
[3 NO
STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT.
............ FT.
REMARKS
METER SIZE SERVICE SIZE I CLEARANCE
ICHECKED BY
REMARKS
TYPE CONNECTIO14
VERIFIED BY
PERC. TEST
PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPrRO
I
N
;0
10 O_
SPECIAL INSPECTOR REQUIRED
C] YES
OCCUPANCY GRUUP
I
PLAN CHECKED BY
Plan Check No ................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
M
Fee
r
Pm
No.
T TOTAL AMOUNT DUE �, j
OTAL UNT k_)(Y/7
ATTENTION APPLICATION APPROVAL
T T US
HIS PERMIT This application is not a permit until
AUTHORIZI
AUTHORIZES eigned by the Building Official or his Dep-
J� Y IC
ONLY THE
J'� 7 uty; and fees are paid, and receipt is ac
.0 � r.OT,
WORK NOTED knowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
I
L/ - ( _;f) __?
FILE
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