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BUILDING DEPARTMENT Applicant FlU
'HERMIT APPLICATION Inside IieaYy Linos
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NEWFET
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
❑
SIGN
❑ ADD
❑
ININGTA
WALL
❑
DEMOLISH
ALTER
❑
ORFILLEXCAVATE
FENCE
•..........)
REPAIR
❑
IN P.PRE-
�❑�
1 I
L_F
swim
POOL
VUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NO.: PERMIT!
NUMBER
9
0 YES ❑ NO
EXISTING STREET R/W .. �..,sFT• DEFICIENCY
//'yTHIS PROPERTY
COMP. PLAN ST. R/W-117t�....FT. ..0... FT.
REMARKS
I CHE
METER SIZE I SERVICE SIZE I CLEARANCE I CHECRED BY
REMARKS
TYPE CONNECTION — I VERIFIED BY
PERC. TEST I PERMIT NUMBER
REMARKS
FIRE I TYPE OF CONSTRUCTION STREET IMPROVI
5160 I YES No
Cj YES
NO
PLAN CHECKE BY _TFIfS SITE IS LOCATED IN THE
W. CITY OF EDMONDS. LOCAL SALES
REMARKS TAX SHOULD BE CODED 31.04.
_ Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING WALL
N
ISWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
NT DUE
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-TION
lating construction; and In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of WashingtonRMIT
relating to Workmen's Compensation Insurance.
IZES
NOTE: Permit Limit One Year (Except DEMOLITIONS whichOTED
TILE
rA
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
31G�AT (ONNOR AGENT) VAT)•%fONjIDTION
�MENT
OF
EDMONDS
NOTE: Applicant S ject to Plan Check Fee
PR 6-1101
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drlveways,
marquees, etc.) will require separate permission.
Valuation I Fee
,Join
No.
- — 1 1n//,
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.
DATE/
FILE
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