750186.pdfI
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`....+ BUILDING DEPARTMENT AppllrmtF7ll
PERMIT .APPLICATIOAI Inside Heavy Lines jog ADD q 7 OA _ �� _ asst W.
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Lam❑ VARIANCE OR NDITIONAL USE
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Q yEe NO PERMIT NUMBER
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PLANNING DEPT. APPROVAL DATE:
al CITY TELEPHONE NUMBER
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STREET
EXISTING STREET R/W ............Fr. DEFICIENCY THIS PROPERTY
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NAME
OMP. LAN ST. R/W .,..........Fr. ............F'C.i
3A Gas & Electric Coe, Inc.
REMARKS
td ADDRESS
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3101 Empire Way South
CHECKED BY ra
CITY
T 1LEPHONE NUMBER
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O Was
I 25-2200
CHECKED BY
Seattle,
METER SIZE SERVICE SIZE CLEARANCE
V STATE LICENSE NUMBER
CITY LICENSE NUMRER
I I
223-01 6
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REMARKS1
1..nl DcecrioUon n3 P[gparly (allow Below
or Attach Four Copies)
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TYPE CONNECTION
VERIFIED BY
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PERC. TEST
PERMIT NUMBER y,
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
Q YES [3 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
1
RESIDENTIAL Q LINE
YES NO
Q Q
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NEW
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
,
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NON-RESIDENTIAL s1cN
OF EDMONDS. LOCAL SALES TAX
❑ ADD RETAINING
REMARKS
SHOULD BE CODED 31.04.
❑ DEMOLISH WAIT'
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❑ALTER E]EXCAVATE ❑ FENCE
OR FILL i.. •'--• •)
X REPAIR OVE SWI I
it
INSPTIF O POOL
NUMBER OF STORIES
'
DWELLING
�• I �•
I
UNITS
'
NATURE OF WORK TO BE DONE
V.luallon Fee Receipt No.
Install gas fuel line and Vent—
Plan Check No.
ing for gas water heater. Repla
ing electric tank, extend water
BUILDING
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3, PROPOSED UBE lines 41
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PLUMBING
3-00
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A PLOT PLAN (Indicate BuildingeCtb.cki, abutting streets)
BEAT & GAB LINE
1
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FENCE
SIGN
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RETAINING WALL
N
SWIMMING POOL
1
DEMOLITION
1
PRE -MOVE INSPECTION'.
EXCAVATION OR FILL
TOTAL AMOUNT DUE
1 hereby acknowledge that I have read this application; that the In.
tormatlon given is correct; and that I a n Ne owner, or the duly author-
ised agent of the owner. I agree to comply with City and elate laws regu-
ATTENTION
APPLICATION APPROVAL
Iating Construction; and In doing the work authorized thereby. no person
Will be employed In vlutnl... of the Labor Code of the State of WaahloBlon
THUS PERMIT
This application is not a pernilt until
relating to Workmen's Compensation Iasurmce.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
utyi and fees are paid, end receipt Is ac
.hall be complo d In e4g ly days; MOVED -IN BUILDINGS shall be Co.-
Imowledged in space provided.
plctctl la elg p s.)�
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SIGN it LVImR O AGENT) DATE SIGNED
e�h
INSPECTION
DEPARTMENT
DIR OR•8 BHINATIRE L -.,.r.
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a Ary so V. Pres [ 4-2 —Z
CITY OF
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EDAIONDS
DATE
NOTE: Applicant Subject to Plait Check Fee
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775-2525
This P—olt c Work to be done on Prlv¢te property ONLY*
Anyconstruct... on the Public domain (curb., sidewalks, driveways,
FILE
marquees, Cie.) .111 require separate permission.