710291.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
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Applicant Fill
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&AP NO.:
PERMIT
NUMBER 710291
O YES 0 NO
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ADDRESS
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
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CITY
TELEPHONE NUMBER
REMARKS
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NAME
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AD 88
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CHECKED BY
CITY
TELEPHONE NUMBER
METER SIZE SERVICE SIZE CLEARANCE
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STATE LICENSE NUMBER
CITY LICENSE NUMBEH
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REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
FIRE ZONE I TYPE OF
Iou6T-MEMOR (I
® RESIDENTIAL
NEW T
NON-RESIDENTIAL
ADD ❑
DII EXCAVATE
ALTER ❑ OlFILL
❑ REPAIR O IN P.
❑
El
O
GAS
LINE
SIGN
RETAINING
FEN..x.......... Ft.)
POOL
❑ YES ❑ NO
PLAN CHECKED BY THIS SITE IS LOCATED IN T
CITY OF EDMONDS. LOCALS L
REMARKS SHOULD BE CODED 31. ,
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(UMBER OF STORIES
NUMBER OF
DWELLING
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UNITS
tAATURE OF WORK TO BE DONE
ZIP
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PI Check No
Valuation
Fee
Receipt No.
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BUILDING
PROPOSED USE
PLUMBING
+1 2 O a I ..
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT A CAB LINE
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FENCE
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SIGN
RETAINING WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
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EXCAVATION OR FILL
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TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given to correct; and that I am the owner, or the duly author.
(zed agent of the owner. I agree to comply with city and elate ]awe toga-
ATTENTION
APPLICATION APPROVAL
Iating 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
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
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signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
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Uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
knowledged in space provided.
pleted in six months.)
IIGNATU E (OWNER OR AGENT) DATE SIGNED
INSPECTION
D1R OR'S GNATU 1
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DEPARTMENT
CITY OF
EDMOND$
DATE i,
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
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This Permit covers work to be done on private property ONLY.
Any construction on the public domaln (curbs, sidewalks, driveways,
FILE
marquees, etc.) will require separate permission.
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