710164.pdfI�aAww,
e. BUILDING DEPAR
T
ENSE NUMBER
rlptlon of Property (S.
r i
N T Applicant Fill
N Inside Iieavy Ltf
VCh ♦ Lei
TELEPHO/N`EE NUM
IIE�:R^
or Attach Four Coples)
1�� y s
t � L55
no ' TftC-�
WrNEW
El RESIDENTIAL
❑
GAS
LINE
NON-RESIDENTIAL
❑
IJCI
ADD
SIGN
RETAINING
ElDEMOLISH
WALL
FENCE
ALTER ❑
ORFILLEXCAVATE
xFt.)
El
REPAIR
IIBP.
^❑
I I
..........
WIM
POOL
II__FF
NUMBER OF STORIES
I NUMBER OF
DWELLING
r�
UNITS
NATURE OF WORK TO BE DONE
Ir7.
L,
ti
PERMIT
NUMBER
710164
YES i] NO
EXISTING STREET R/W ........... FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W .... ....... FT. ............FT.
C.
WC
OF CgNA34tUCTIC
,� I �1+ I [] YES ]&NO
9 CIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES %IcNO ( C — "5
E
Plan Check No .....................
—
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING
WALL
N
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 Is correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and elate lawn 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 DEMOIATION8 which
ONLYLE
WORK No ED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
3IG;J,kT OWNER OR AGENT)
DATE 83GNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plats Check Pee
PR a -Tier
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
S1lB�4R_*-r Zo 09C 1776
Valuation 6
99-1
Fee
a
m
No.
I I /t/o 6�h0o9
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-
knowledged in space provided.
:a -
FILE
1
i
i
I
I
i
I
A