700526.pdfBUILDING DEPARTMENT I Applicant FIU
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
of WM • t7/� t��^�.t��il/�
A�I1N0 ADDRESS
O CI yam'' TELEPHONE NUMBER
NAME
�i
ADDRESS
Y
��. CITY TELEPHONE NUMBER
3 O /P w4 rflL.oFp 0/7"Gl 141;e *Ar
4 CITY TELHOHONE NUMBER
STATE LICENSE NUMBER CITY LICENSE NUMBER
xX3 OR /mod
Legal Description of Property (Snow Below or Attach Four Copies)
GAS
RESIDENTIAL LINE
NEW
ElNON-RESIDENTIAL BION
ADD ❑ DEMOLISH Elw T.rARiIN6
CALTER ❑ EXCAF LL,N s_..._..Ft.)
REPAIR El INPMOVE ElBWIL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
(1.- '0 do Ts
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-
ized agent of the owner. I Kites to comply with city and state laws 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 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 constructim on the public domala (curbs, sidewalks, driveways,
marqueesp ere.) win require separate permission.
..._�
riaeaa.�nnaKe».mi��ei
KROLL-MAP NO.; PERMIT 7
NUMBER 00526
'. AA /q q*\
Plan Cheek No._._._......_...
[0346h93okle'
0*Ai)1.ic14k[i'
1 4 �8 & D M
M) HMG]wY s Z-1
EXCAVATION OR
ATTENTION
TIUS PERMIT
AUTHORIZES
ONLY THIN
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
Pa 6.1107
YES 13 NO
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C799
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YES i] NO ? -
Fee
/ /. 00 C srI 83 f I
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APPLICATION APPROVAL j
This application is not a permit until i
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac- p
lmowledged in space provided.
.� +' 7f •�
DATE (�
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