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PERMIT APPLICATION
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ITATE LICENSE NUMBE
,;�-23-ot- 6&3
Inslao Heavy x.11les
PERMIT NUMBER 710215
A,cd.
YES ❑ NO
EXISTING I STREET R/W ............FT. DEFICIENCY THIS PROPERTY
ELEPHONE UMBER
/J HU ER COMP. PLAN ST. R/W ............FT. ............FT.
' /,17 %0.4i — SX1 REMARKS
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TELEPHONE NUMBER
or
NEW
EJ RESIDENTIAL
GAS
LINE
NNON-RESIDENTIAL
/�
SIGN
ADD
RETAINING
❑
DEMOLISH
WALL
ALTER
❑
EXCAVATE
ORFILL
❑
FENCE
x.......... Ft.)
REPAIR
j�j
I '
PRE -MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
I
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 slate 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 core-
Dle d In six months.)
1—��-71
E: Applicant Subject to Plan Check Fee
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.
STREET IMPROVED
❑ YES ❑ NO
❑ YES ❑ NO
SCCTto 12.13.11.0 CITY Copt-
T-o-mu AaFA \Z) s tatJS 1 o6% sty,. r-T
15a ° t ?GT4 t I I U
Plan Check No .................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
elax
RETAINING WALL —
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Valuation
0 IN
Fee
0
No.
TOTAL AMOUNT DUE
ATTENTIO''N
APPLICATION APPROVAL �
THIS PEnMTr
This application Is not a permit until
AUTHORIZES
signed by the Building Official or his Deg- 1
WORK THE
uty; and fees are paid, and receipt Is ac-
WORK NOTED
knowledged in space provided.
INSPECTION
DIRECT '8 8I T RE i
DEPARTMENT
CITY OF
EDMONDS
DATE
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^ so ^
PR 6-1107
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RECORD OF INSPECTIONS
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1.4L Date Passed
Foundation 517/ d%
i y. Plumbing (Partial)
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�. R°ugh)
Frame
:
Furnace & Fuel Lines —.
Final S 7Z
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I I,RECORD OF INSPECTIONS
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_ Date:P6ssed
Drainage ti
Sewer
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Ser a
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Parking
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F } Fire Dept. s� s
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