710107.pdfBUILDING DEPARTMENT AppucantFill
PE MIT APPLICATION I Inside Heavy Lines
+� NA
/I r%
O
a
z
3
IZ4'1 ` 11 / L
TELEPHO.
7 74
AD 8B
CITY TELEPHONE NUMBER
C
RESIDENTIAL
GAS
El NEW
LINE
ADD
NON-RESIDENTIAL
❑
SIGN
❑
RETAINING
El
DEMOLISH
FENCE
ALTER
❑
ORFILL
❑
REPAIR
❑
IN INSP.
O
..........Ft.)
swim
IUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
21
PERMIT
NUMBER
,
❑ YES
3
❑ NO
'UMBER a
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
CONNECTION
❑ YES ❑ NO
Plan Check No .....................
BUILDING
PLUMBING
HEAT & OAS LIN
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 elate 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
THIS PERMIT
Workmen's Compensation Insurance.
reKt;!
AUTHORIZES
NPermit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
smpleted In ninety days; MOVED -IN IIUILDIlr'65 shall be com-
pix months.)
Il :UIiE (OWN A )
DATA SIGN
INSPECTION
7
DEPARTMENT
CITY OF
EDDIONDS
E: AhPlicant 1 ie o Plan Check Fee
PR 8-1107
This Permit covers work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
❑ YES ❑ NO
Fee
V 0
No.
Id,
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.
I
FILE
1
_
I �
i
r
'
I.
,
4 r
:
C
n
e
i•'
r.
,
r '
r-:
1 ,
• 1 Y {.
r' y
,
I }
._ .. ,..
r
i
14
.. Kj ..
RECORDLOF INSPECTIONS
Date Passed , 1
Foundation
'1
N -34-
Plumbing (Partial)
(Rough)
Frame
Furnace & Fuel Lines
1
Final °
r
f�
RECORD OF INSPECTIONS i
Date Passed r t ,;
Al
" Drainage'
Sewer
Parking „! ;„
Landscaping ------- - — ,.y
Fire Dept. 1
e'. {