710453.pdfa
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DING DEPARTMEN
MIT APPLICATION
Applicant Fill
Inside Heavy Lines
TMLEPHONZ NUMBER
�� r�a►et 17113 18 3 ¢
M1 �
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NUMBER 71045:3
— � �� �1� Ott W � •.
EXISTING STREET R/W ............FT.
COMP. PLAN ST, R/W ............FT.
�' METER SIZE I SERVICE E
NUMBER CITY LICENSE NUMBER
5
!1i.5
�;:.!_:.: ' REMARKS
peon of Property (Show Below or Attach Four Copies)
e.c.,
TYPE CONNECTION
PERC. TEST
REMARKS
FIRE ZONE TYPE OF
SPECIAL INSPECTOR HE(
GAS ❑ YES ❑ NO
SIDENTIAL ❑ LINE
NEW PLAN CHECKED BY
NON-RESIDENTIAL ❑ SIGN
ADD ❑ WALL KING REMARKS
❑ DEMOLISH
ALTER CE
❑ ORCFILL E ❑ FEN...x.......... Ft')
REPAIR ❑ PRE -MOVE SWIM
INSP. POOL
NUMBER OF STORIES I NUMBER OF
DWELLING
UNITS
NATT OF WORK TO BE DONE
n KW
IAi G�• . • -,� Plan Check No, ....... _...........
lSw KW rLLrc.TR1 UL 1nAgii 1RG1i BUILDING
PROPOSED USE
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT A GAS LINE
gl
n
FENCE
SIGN
tRETAINING WALL
N
1 SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
ETBACK (REAR YARD SETBACK •�
y(7
VACANT SITE
❑ YES Cl NO
AREA I VARIANCE NUMBER
:
d
DEFICIENCY THIS PROPERTY
............FT,
■ ■ IZ9
CITY OF EDMONDS, LOCAL
Valuation
Fee Receipt No,
TOTAL AMOUNT DUE I I , O O �1
I hereby acknowledge that I have read this application; that the In- 1
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 state laws regu- ATTENTION APPLICATION APPROVAL
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 This application Is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
ONLY
shall be completed In ninety days; MOVED -IN BUILDINGS shall be corn- knowledged in apace provided,
pleted In six months.)
SI U O OR A6 T DATE S14
IGNED INSPECTION D OWB SI TU
04 DEPARTMENT
CITY OF DATE
EDMOND3
NOTE: Applicant Subject to Plan Check Fee Pa OND '
6-1107
This Permit covers work to be done on private property ONLY,
Any construction on the public domain (curbs, sidewalks, driveways, FILE
marquees, etc.) will require separate permission.
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RECORD OF INSPECTIONS
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Date Passed
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a ;. Foundation. '
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Plumbing (Partial)
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i Furnace & Fuel Lines -�
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Final
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RECORD OF INSPECTIONS
Date; Pa
Passed '
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, �.... Drainage , . 1 s,
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Sewer,{ iY. r 1 it
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Parking.
f Landscaping
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