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BUILDING DEPARTMENT Appuctntirm
PERMIT APPLICATION
Inside Heavy Lines
NAME <
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TELEPHOND NUMBER
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CITY..
TELEPHONE NUMBER
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• (PHONE
NUMBER
•: ' 8 E LICENSE NUMBER
CITY LICENSE NUMBER
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: Legal Description of Property (Show Below or Attach Four Copies)
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NEW
El RESIDENTIAL
❑
GAS
LINE
NON-RESIDENTIAL
❑
SIGN
ADD
RETAINING
F
❑
yEALL
DEMOLISH
ALTER
❑
OROFILLTE
❑
(ENC;..........Ft.)
REPAIR
❑
INSP.
swim
POOL
(UMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
NUMBER
:3.10
c
VACANT SITE
❑ YES ❑ NO
VARIANCE NUMBER
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
FIRE
❑ YES
❑ NO
OF
�0
Plan Check No .....................
BUILDING
d. PROPOSED USE
PLUMBING
A PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT A GAS LINE
22
n
FENCE
SIGN
RETAINING WALL
N
ISWIMMING
POOL
DEMOLITION
PRE -MOVE INSPECTION
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-
ized agent of the owner. I agree to comply with city and state laws regu- ATTENTION
Iating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Waahington THIS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY TILE
NOTE: Permit Limit One Year (Except DEMOLITIONS which {SORB NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shalt be com-
pleted In six months.)
IIGNATURE (OWNE'NT) DATE SIGNED INSPECTION
i I DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plat Cbeck Fee
__. PR 8-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation
❑ YES ❑ NO
A 3- 9-
No.
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-
knowledged in space provided.
DATE
FILE
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RECORD OF INSPECTIONS
Date Passed I
Foundation
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- Plumbing (Partial) "p
(Rough) — �— 7� ;?
Frame
'Furnace f.
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Furnace &Fuel Lines ,
Final
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A 5,
ECORD. O.F INSP. ECTIONS
Date Passed
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Drainage .
Sewer i I
„. Parking I
_ - Landscaping
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