710317.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
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Applicant Fill
Inside Heavy Lines
NEW
RESIDENTIAL
AS
INE
,®.
❑ NON-RESIDENTIAL
❑
SIGN
ADD
NINE
RETAINING
El
PENCE
ALTER
❑ OROFI LTE
Ft.)
.x._.......
REPAIR
PRE -
INSP.
swim
POOL
NUMBER OF STORIES I NUMBER OF
DWELLING
UNITS
rA
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
N
ISWIMMING
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
PERMIT 7 1 0317
NUMBER
❑ YES ❑ NO
DEFICIENCY THIS PROPERTY
............FT.
iL
❑ YES ❑ No
i
1
1
THIS SITE IS LOCATED IN THE
CITY OF EDMONDS, I OCAL SA E
TAX SHOULD BE CODED 31. 4.
Valuation
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 slate laws regu-
ATTENTION
APPLICATION APPROVAL
�.
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
TIUS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
-
signed by the Building Official or his DepONLY
j
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
TEL
WORK NO ED
utyi and fees are paid, and receipt is ac-
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shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
1tnowledged in space provided.
p 'd In six months.)
1 O ATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DIRECTOR' BIGNAT
i
DEPARTMENT
yC
v
CIOF
EDBIONDS
DATE
4
NOTE: Applicant Subject to Plan Check Fee
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PR 0-1107
This Permit coven work to be done an private property ONLY.
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Any construction on the public domain (curbs, sidewalks, driveways,
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marquees, etc.) will require separate permission.
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