710357.pdfBUILDING DEPARTMENT
t PERMIT APPLICATION
0
f-
VcP3—
El NEW
ADD
ALTER
REPAIR
Applicant Fill
Inside Heavy Lines
V
or
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
❑
SIGN '
❑RETAINING
DEMOLISH
WALL
❑
FENCE
❑EXCAVATE
OR FILL
(......... A .......... Ft.)
PRE -MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
t
N
I
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 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 State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shalt be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.) .
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 permission.
7,
0 —
EXISTING STREET R/W ........ ... FT.
COMP. PLAN ST. R/W ...........1".
❑ YES ❑ NO
Plan Check No .....................
BUILDING
PLUMBING
HEAT & OAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
PERMIT
NUMBER
❑ YES
❑ NO
DEFICIENCY THIS PROPERTY
........ ... TV.
STREET IMPROVI
❑ YES ❑ NO
THIS SITE IS LOCATED IN THE
TAX SHOULD BE CODED 31.04.
Valuation I Fee
� n �
P�
No.
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. /f
/.
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RECORD OF INSPECTIONS,
Date Passed
Foundation N
. Plumbing (Partial)
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(RO;Ioh) 111
Frame
Furnace & Fuel Lines
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