710415.pdfC
to
BUILDING DEPARTMENT
PERMIT APPLICATION
Applicant Fill
Inside Heavy Lines
I—aftArn
KWIC
s
G$08)—MLIS •W .
!E2"Ewoz
or
336T
LINE
ElRESIDENTIAL
NEW
NON-RESIDENTIAL
❑
SIGN
RETAIADD NINE
WALL
DEMOLISH
ALTER
❑
OROFIILTE
PENCE
...x.......... Ft.)
REPAIR
❑
PRE -MOVE
a
Pwim
OOL
(UMBER OF BTORIEB
NUMBER OF
DWELLING
UNITS
QATURE OF W0JtK TO BE DONE
-t�L
EXISTING STREET R/W ...... ..... FT -
COMP. PLAN ST. R/W ............FT.
FIRE
YES NO
PERMIT
NUMBER
YES
0 NO
DEFICIENCY THIS PROPERTY
❑ YES 13 NO
PLAN CHECKED BY THIS SITE IS LOCATED IN THE
CITY OF EDMONDS. LOCAL SALT
REMARKS TAX SHOULD BE CODED 31.04
_
Plan Check No .....................
BUILDING
PLUMBING
BEAT h GAS LINE
FENCE
ISWIMMING
SIGN
RETAINING WALL
POOL
DEMOLITION
PRE -MOVE INSPECTION
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 state 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 TICE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
SIGN R AGENT DATE IGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will reQatre separate permiseton.
Valuation I Fee
570
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.
i
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RECORD 0 INSPEC I NS
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Plumbing (Partial) I il.
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i Furnace & Fuel Line
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Final /2 7� x,;
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No
RECORD.OF INSPECTIONS._._....__..._....III
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Sewer
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No No: ol;
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