710472.pdf`
p�v,BUILDING DEPARTMENT
ra
AlPERMIT APPLICATION
NAME (OR NAME OF BUBLNEss)
Edmonds
$ ' '
O ADDRE88
250 - 5th Ave. No.
CITY
ie'rl
Edmonds
ADDRESS
North
Applicant Fill
Inside Heavy Lines
776-1107
or
2-6565
13 YES CNO
4� v
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............1".
rN
4> i 7W
Y
0 ov.�
PERC. TEST I PERMIT NUMBER
W REMARKS
Q .
a cdEC Cd y..EcriCir Ivor
E
O
FIRE I TYPE OF CONSTRUCTION STREET ❑ NO
T IMPROVE
NL YE
NEW
RESIDENTIAL
GAS
LINE
®
NON-RESIDENTIAL
SIGN
ADD
KING
❑
❑
WALL
DEMOLISH
FENCE
ALTER
❑
ORFILL
❑
Ft.)
REPAIR
❑
PRE -swim
INSP.
.x..........
POOL
❑
DWELLING
UNITS
C] YES )5�0 I E_ I
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE
REMARKS riTY nF FnE,40 7S- LOCAL SALES
TAX SHOULD BE CODED 31.04.
GIAUOFLiN1c� S I viers 50t3JtCT
�ro Ft 2c CJ 9T P4K UVAk(,
� t ►JS P��i' I 0 hJ
z-
(S
Gons%yucta oil ni- Ull1U1..L11C A LUL.aAv
Plan Check No .....................
in connection with Sewage Treatment Plant
_F.xnanc; en Phase II .
BUILDING
y
y�
�'
PR 0-- O BLED UBE�
_ steraae
PLUMBING
.a
31
n
PLOT PL (Indicate Building setbacks, abutting streets)
N
ISWIMMING
HEAT do GAS LINE
FENCE
SIGN
RETAINING WALL
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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 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.
NOT Permit Limit One ear (Except DEMOLITIONS which
shell a e ed to oety day OVED-IN BUILDINGS shall be oom-
pleteq�ix months.)
NOTE: 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.
TOTAL AMOUNT DUE
ATTENTION
TICKS PERMIT
AUTHORIZES
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
Valuation I Fee
APPLICATION APPROVAL
No.
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.
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