710181.pdfB O I L ®I III G u t to A K I IVI C F41 I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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NEW
❑ ADD
❑ ALTER
❑ REPAIR
or
RESIDENTIAL
R
GAS
LINE
NON-RESIDENTIAL I
❑
SIGN
❑RETAINING
DEMOLISH
WALL
❑EXCAVATE
OR FILL
FENCE
(.......... x.......... Ft.)
PRE -MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
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I hereby acknowledge that I have read this application; that the In-
formation given In correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and slate 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
relatlog to Workmen's Compensation Insurance,
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED-111 BUILDINGS shall be com-
pleted In nix months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sldewallts, driveways,
marquees, etc,) will require separate permission.
TBACK I STREET`Si
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
❑ YES ❑ NO
Plan Check No ....................
BUILDING
PLUMBING
HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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❑ YES
DEFICIENCY THIS PROPERTY
............FT.
Valuation
❑ YES ❑ NO
Fee
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No.
TOTAL AMOUNT DUE I I h 0 a V& 0 M
ATTENTION APPLICATION APPROVAL
TIUS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or lids Dep-
ONLY THE
ORK
NOTED WORK uty; and fees are paid, and receipt is ac-
lmowledged in apace provided.
INSPECTION DIR 'OR'8 ONATU E /
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
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RECORD OF INSPECTIONS
rd
_ Date Passed
,
Foundation
_. (Partial)
---
Plumb•{ng
(Rough)
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Frame
Furnace & Fuel Lines i
s . Final
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... ....
RECORD OF INSPECTION
Date Passed > i J
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Drainage o - ;tt
7
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Parking .
Landscaping
Fire Dept&
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