700196.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF 11111Z a t4
MAILING ADDRESS
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C4 ADDRESS
I CIT
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STATE LICENSE NUMBER
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Applicant FLU
Inside Heavy Lines
S r,
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or Attach Four
KNEW
RESIDENTIAL
GAS
LINE
E]
NON-RESIDENTIAL
SIGN
RETAINING
ElDEMOLISH
WALL
EXCAVATE
FENCE
ALTER
M
OR FILL
( x Ft.)
REPAIR
El
PRE -MOVE
INSP.
.......... ..........
swill
POOL
IUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
I KROLL MAP NO.: PERMIT
NUMBER 700196
[3 YES [3 NO
EXISTING- STREET R/W ............ F-r- DEFXCrENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ I.T.
REMARKS
0 YES [] NO
REMARKS
,;�'o
I;FZ_ _e erWj(� -_ -C/-
Plan Check No .....................
Z
0
BUILDING
A
PROPOSED USE
PLUMBING
HEAT & GAS LINE
PLOT PLAN (Indicate Building setbacks, abutting streets)
tRETAINING
N
FENCE
SIGN
I
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby arknowledge that I have read thla application; that the In-
formation given In correct; and that I am the owner, or the duly author-
lzed 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 Insurance. AUTHORIZES
ONLY TILE
NOTE: Permit Limit One Year (Except DEIMOLITIONS which WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
lIG RE (OWNER OR AGEN TE IGNE INSPECTION
DEPARTMENT
76
4110-2 -
7,41� V I __ CITY OF
�"- fiig�_ Z EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) %will require separate Permission.
Valuation
[] YES [:] NO
Fee
e-c)
Z
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-
Imowledged In space provided.
FILE:
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