710085.pdfz
UILDING DEPARTMEN
PERMIT APPLICATION
or
Applicant F111
Inside Heavy Lines
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C.
ROLL MAP NO.:
PERMIT
/ 'NUMBER
YES Q NO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
GAB ❑YES ❑ NO
RESIDENTIAL LINE PLAN CHECKED BY
NEW ❑ NON-RESIDENTIAL
BION
ADD ❑WALLTNINE REMARKS
DEMOLISH
NCE
ALTER ❑ ORFILL
EXCAVATE (........... x.......... Ft.)
REPAIR a PRE -IN P. POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
f of s d / f� c9 G� !�! a c -2
, c Plan Check No ....................
BUILDING
PROPOSED UBE
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT & GAB LINE
FENCE
SIGN
tRETAINING 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-
Ised agent of the owner. I agree to comply with city and state laws 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 THUS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NM: Permit NMR One Year (Except DEMOLITIONS which WORK NOTED
Af�all b complete ety days; MOVED -IN BUILDINGS shall be com-
pleted a six ths.)
1I0 TURNF WOR AGENT) DATE IONED INSPECTION
y DEPARTMENT
✓jS QITY OF
NOTE: Applicant Subject to Plan Check Fee EDMONDS
PR 6-1107
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.
❑ YES ❑ NO
Valuation I Fee
J 0
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.
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