700242.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
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Applicant Fill
Inside Heavy Lines
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LINE
NON-RESIDENTIAL
El
SIGN
RETAINING
WALL
DEMOLISH
ALTER
EXCAVATE
OR FILL
LLJ
FENCE
( x Ft.)
......... . ..........
REPAIR
PRE -MOVE
INSP.
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Ps WOO,
rUMBER OF STORIES
NUMBER or
DWELLING
UNITS
PORTED ON KROLL MAP NO.: PERMIT
NUMBER
i
13 14FY-,
STREET SETBACK
;�_ S
[UUZ14e
AR YARD SETBACK
13 YES MNO
EXISTING- STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT.
C] YES
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
A,
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-
lzed agent of the owner. I agree to comply with city and state Iowa 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 PE19BUT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; hIOVED-IN BUILDINGS shall be com-
plet9i in six months.)
at OWN UVOR AGENT)
DATE SIGNED
INSPECTION
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/__ /// /4
DEPARTMENT
OF
CITY
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
This Permit covers work to Im done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
joarquees, etc.) will require separate permission.
Valuation
No.
[:] YES 13 NO
Fee
le
'40000
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-
Imowledged in space provided.
FILE
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RECORD OF INSPECTIONS
Date Pa
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Foundation
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Plumbing (Partiij)
(Rough)
Frame
Furnace & Fuel,L
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-INSPECTIONS
RECORD
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4 1 1 sl I L jr! t Date' Passb&
Drainage
sewer
....4 Parking
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