710206.pdfl'
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UILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
5
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21
OAS
RESIDENTIAL LINE
NEW NON-RESIDENTIAL
SIGN
ADD ❑RETAINING
DEMOLISH ❑ WALL
ALTER ❑ EXCAVATE ❑ EN
CE
ORFILL (.
...x.......... Ft.)
PRE -MOVE SWIM
REPAIR ❑ INSP. POOL
DWELLING
UNITS
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 state laws regu-
lating construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Stale of Washington
relating to Workmen's Compensation Insurance.
MOM Per iinit One Year (Except DEMOLITIONS which
hall T comp ed 1 ninety days; MOVEDdN BUKLDINOS shall be oom.
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, sidewalks, driveways,
marquees, etc.) will require separate permisslon.
FROM YAP NO.: I PNUMERMIT 710206
a/ ).4 41 SA
I I❑YES
NO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
FIRE ZONE I TYPE OF CONSTRUCTION
SPECIAL INSPECTOR REQUIRED Iocc
❑ YES ❑ NO
PLAN CHECKED BY
REMARKS
�
Valuation
Plan Check No .....................
BUILDING
PLUMBING
BEAT h GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1101
❑ YES ❑ NO
F3�
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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RECORD OF INSPECTIONS ,
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