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BUILDING DEPARTMENT ApplicaDt M
PERMIT APPLICATION Ins'de Heavy unes
'77 ';A- Llel & 0
— 10(o —t-A' 5 C') -
L'-3 a 0-1Z,
PERMIT
NUM13ER
--izs - % -J� I 10 YES
USTING STREET R/W ............ FT -
COMP. PLAN ST. R/W ............ FT.
I.
NO
DEFICIENCY THIS PROPERTY
4
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REMARKS
Legal Description of Property (kinow Below or Attach Four Copies)
TYPE CONNECTION
VERIFIED BY
PERC. TEST
PERMIT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
alr— [] YES 13 NO_
SPECIAL INSPECTOR REQUIRED
[3 YES 1$6 NO
OCCUPANCY GROUP
GAS
51 RESIDENTIAL LINE
NEW —
NON-RESIDENTIAL SIGN
j RETAINING
DEMOLISH WALL
ALTER EXCAVATE PENCE
OR FILL ( ........ . x .......... Ft.)
PRE -MOVE swim
REPAIR El INSP. POOL
PLAN CHECKED BY
REMARKS
<)
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
Z
NATURE OF WORK TO 13E DONE
:P 4tA��
Plan Chock No .....................
Valuation
Fee
Receipt No.
BUILDING
Q
92
0
ft
PROPOSED U13E
PLOT PLAN (Indicate Building setbacks, abutting streets)
tRETAINING
N
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-
Ited. agent of the owner. I agree to comply with city and state lawn 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 Umit One Year (Except DEMOLITIONS which
shall be completed In ninety day#; MOVED -IN BUILDINGS shall be com.
pie n a months.)
810 ATURE (OWNER 0 GENT) TE SIGNED
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curb@, oldownIkso driveways,
marquees, etc.) will require separate permission.
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1101
E��
��77
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or bis Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
DIRECTOR'S/qIGNATU
FILE
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