700479.pdf,BUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
ANNEMr
K"WAR)
C
NO.: PERMIT
NUMBER 7004
V _f
TIC I STREET SETBACK
us LOW A.RWIL VAU"
TE—LEPRONE NUMBER [3 YES
Orry
77v1—o2eo?9f HE BUILDING VARIA
ADDRESS
STREET R/W
TELEPHON9 —NI USER EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
CITY
COUP. PLAN ST. R/W ............ FT. ............ FT.
REMARKS
NA21E
III ADDRESS
.RL
CHECKED BY
CITY m"PAIWE NUMBER
8 7 METER SIZE SERVICE SIZE I CLEARANCE ICHECKED BY
STAaE LICENSE NUMBbut CITY LICENSE NUMBER
REMARKS
Legal Description Of Property (Show Be
low or Attach Four Copies)
TYPE CONNECTION VERIFIED BY
Z
PERC. TEST PERMIT NUMBER
REMARKS
0
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES [3 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
GAS 0 YES tj NO
NEW RESIDENTIAL El LINE PLAN CHECKED BY
NON-RESIDENTIAL 0 SIGN
DRETAINING REMARKS
ElDEMOLISH 1:1 WALL
DALTER EXCAVATE FENCE 9, o Z
1:1 OR FILL 1:1 ( ........ . X ..........
REPAIR PRE -MOVE swim
INSP. EIPOOL st 474
Z
DWELLING
UNITS
t
N
I
I hereby acknowledge that I have read Win application; that the in.
formation given to correct; and that I am the owner, or the duly author-
ized 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
totaling to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEHOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
Valuation I Fee
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
No.
TOTAL AMOUNT DUE I 1 1, &.,n U51 33
ATTENTION APPLICATION APPROVAL LO
THIS PERMIT This application is not a pernilt until
AUTHORIZES signed by the Building official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
q (OWNER 0 ENT) DATE SIGNED INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Vbject to Plan Check Fee PR 6-1107
This Permit covers work to be done an private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
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