700527.pdf----------
BUILDING DEPARTMENT Applicant FBI POSTED ON KF
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
NAME MR-NIME-CF-M -1 1 Z q
t
a
Z
4.01lu I le�e—e67Z5161'
IESS
77;;V4 4=107— t4L- 40
90 W': 0" U, a 5 1
or
I
E] RESIDENTIAL
1—Hr, I
El
GAS
LINE
'aNEW
NO
R
SIGN
ElADD
RETAINING
RDEMOLISH
WALL
EXCAVATE
FENCE
ALTER
R
OR FILL
( x Ft.)
REPAIR
PRE -MOVE
.......... ..........
swim
INSP.
POOL
DWELLING
UNITS
I hereby acknowledge that I have read this application: that the In-
formation given In correct; and that I am the owner, or the duly author.
Ized agent of the owner. I agree 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 Workmenla Compensation Insurance.
N01 . Pe nt Imit One Year (Except DEMOLITIONS which
h it e I'
al I b!oco Weted rinety days; MOVED -IN BUILDINGS shall be eom-
m ha.)
pleted In a no hs.)
I'
N0rrE_: Applicalit Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewnlksp driveways#
marquees, etc.) will require separate permission.
PERMIT
NUMBER
NMI:
El YES [3 NO
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT.
REMARKS
Z
N
C] YES Cj NO
REMARKS
Plan Check No ............
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
AT=NTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
BY
00
0 YES [3 NO
Fee
No.
I I �).00 V�79ci
APPLICATION APPROVAL /
This 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.
11
� I— �
FILE
RECORD OF INSPECTIONS
Date Passed
Foundation
-n
..'.....Plui bing.(Partial)
(RoCi
gh
I LP
Fri
P A a m e
Fuf;r:nace.& Fuel�.Line
ina
I L
Ile
RECORD'O F! I N SPEQTIqN S
Date Passed,
I L
L, L
Drainage
Sewee
Parking
11 P -L
L A f .1,
Landscaping
Jt
Fire Dept,
I
r�k
I I I