700291.pdfQ
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BUILDING DEPARTMENT Applicant FIR
PERMIT APPLICATION Inside Heavy 1,11-ats
I MAArNG A_DDIMSS F_
ISCA e4slip-d—i r� Py R"
ADDRESS ' '
/ / .2- o 59 e4'
6-- i�-34C
ICENSE NUMBER
PERMIT
NUMBER
EWA=
0 YES
700291
F�d
7-
T__1 I
E3 NO
T—M B E _R
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT.
Ij YES [:] NO
9
q
7=: .
GAS C] YES NO
NEW LINE
PLAN CHECKED BY
E] SIGN
FADD RETAINING REMARKS
DEMOLISH WALL o
1:1 El
ALTER EXCAVATE PENCE
OR FILL .......... x .......... Ft.) T
REPAIR PRE -MOVE SWIM
El INSP. POOL i
ES NUMBER OF
DWELLING
UNITS
Ile -
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
ih In
,a'
formation given In correct; and that I am the owner, or the duly author-
y au
Ized agent of the owner. I agree to Comply With City and state lawn regu-
awe re 0 'r
ATTENTION
lating construction; and in doing the work authorized thereby, no person
no person
will be employed In violation of the Labor Code of the State of Washington
jj
TIUs PERMIT
relating to Workmen's Compensation Insurance.
AUTHOIIUZES
I '
NOTE: Permit Limit One Year (Except DE51OLITIONS which
ONLY THE
WORK NOTED
aball be completed in ninety days: MOVED -IN BUILDINGS shall be com-
pleted In nix months.)
;IGN TU 0 V ER �.R AGENT)
!2Y
UNL
DATE SIGNED
'D
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
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.
Valuation I Fee
APPLICATION APPROVAL
No.
This application is not a pernlit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
FILE
" I
This application is not a pernlit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
FILE
" I
V,
NSPECIIONS
RECORD OF INSPECT-1—
Final
nF INSpECTIONS