710260.pdfBUILDING DEPARTMENT I AppllcantFili
PERMIT APPLICATION Inside heavy Linea
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NAME (Mr
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HAILING A
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ADDRESS
CITY _
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Legal Descrlptlon of Proper y (Show
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RESIDENTIALGAS
LINE
NEW
❑NON-RESIDENTIAL
❑•
SIGN
ADD
❑
❑
WALL KING
DEMOLISH
EXCAVATE
FENCE
ALTER
OR FILL
(.......... xFt.)
ElREPAIR
❑
PRE -MOVE
INSP.
..........
swim
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
/
1
I UNITS
NATURE OF WORK TO BE DONE
1
EXISTING STREET R/W
COMP. PLAN ST. R/W
PERMIT
NUMBER 710260
DEFICIENCY IRIS PROPERTY
Driveway Slopes not to exceed those
indicated on Standard Drawing #103.
CID 164-
/ jam I � j I [] YES JAI NO
SP CIAL INSPECTOR REQUIRED OCCUPANCY O OU I/—
1] YES r` ],NO I �
PLAN CRECKIAD BY I HIS SITE IS LOCATED IN THI
CITY OF EDMONDS. LOCAL SAL
REMARKS I AX SHOULD BE CODED 31.04
5" 0f?>W T?W= 1=RAMIKU-
Plan Check No .....................
BUILDING
PLUMBING
HEAT A OAS LINE
FENCE
SIGN
RETAINING WALL
ISWIMMING
POOL
�•
DEMOLITION
-
-�
PRE -MOVE INSPECTION
I\ h
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 stale 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
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WOK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
IIONATURE (OWNER OR GENT)
DATE SIGNED
INSPECTION
DEPARTMENT
/ - . "
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-I307
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.
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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