700278.pdf7-
POSTED ON K OLL MAP NO.:
PERMIT
F �BUILDING
DEPARTMENT
AppIleaDt Fill
I
NUMBER 7002�8
I
PERMIT APPLICATION I Inside Heavy Lines
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CITY rELEPRONE NUAILU
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RESIDENTIAL
GAS
LINE
NEW
NON-RESIDENTIAL
SIGN
RETAINING
ADD
DEMOLISH
WALL
J
ALTER
EXCAVATE
OR FILL
E]
FENCE
( x Ft.)
.......... ..........
REPAIR
PRE -MOVE
INSP.
1:3
swill
POOL
-NUMBER OF 13TORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
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� PRO
yo OSED USE
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[] YES [] NO
EXISTING , STREET R/W ............ FT. DEFICIENCY THIB PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ a
REMARKS
Z
TYPE CONNECTION
VERIFIED BY
FERC. TEST
PERMIT NUMBER
Cd
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION
STREET IMPROVED
r] YES [3 NO
SPECIAL INSPECTOR REQUI]
YES NO
,Y GROUP
PLAN CHECKED 13Y
REMARKS
Plan Che(
Valuation
I hereby acknowledge that I have read thin 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-
lating construction; and in doing the work authorized thereby, no person
will he employed In violation of the Labor Coda of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED.IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs. sidewalks, driveways,
marquees, etc.) will require separate permission.
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE _gL3 J
ATTENTION APPLICATION APPROVAL
THIS PERMT TW9 application is not a permit until
AUTHORIZES aigned by the Building Off Icial or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
I Imowledged in space provided.
INSPECTION DIRECTOI
DEPARTMENT
CITY OF Z-el,
EDMONDS DATE
PH 6-1107
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