700376.pdfBUILDING DEPARTIVEMNT �JjAppllcant FRI
11 in
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PERMIT APPLICATION Inside Heavy L
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NAME
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ADDRESS
CITY
TELEPHONE NUMBET7_
ON KROLL MAP NO.: PERMIT
NUMBER
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SIDE �79
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11 TBAGK
10-
STREET SETBACK
HEAR
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[3 YES
EXISTING'STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ IT. ............ 1,7r.
NAME
ca ADDRESS
g0 Vi Y'\ e-r V,-�i ty, CHECKED BY 14
A CITY TELEPHONE NUMBER
Z METER SIZE I SERVICE SIZE CLEARANCE CHECKED BY
STATE LICENSE NUMr3ER CITY LICENSE NUMBER
I REMARKS
i 1..�nl Oescrintion of ProDerty (Show Below or Attach Four Copies)
C
MINV�
RESIDENTIAL
GAS El YES El NO
LINE BY
0 NEW
PLAN CHECKED
NON-RESIDENTIALI
SIGN
DRETAINING
El
REMARKS
WALL
DEMOLISH
ALTER
F1
EXCAVATE
OR FILL
D
FENCE
( x Ft.)
I
.......... ..........
REPAIR
EJ
PRE -MOVE
INSP.
El
swim
POOL
'JUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
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-
formation given to correct; and that I am the owmer, 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
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
JiGrRE (OWNER 0 A T) DATE SIGNED
INSPECTION
DEPARTMENT
(9// (170
CITY OF
EDMONDS
NOTE: Applicant eubject 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
M
0 YES [:] NO
Fee I Receipt No.
I a, 0 n 1(7-61;
APPLICATION APPROVAL �
Tbis 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.
I I so -
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