710445.pdfs_
{ BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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NAME
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D ON KROLL MAP NO.: PERMIT
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LONE LOT AREA
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710445 1
❑ YES 0 NO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. _ .......... .FT.
Legal Description of Property (Snow Below or AUS sour vopiee)
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TYPE CONNECTION
VERIFIED BY
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PERC. TEST
PERMIT NUMBER
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REMARKS
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TYPE OF CONSTRUCTION
STREET IMPROVED
❑ YES ❑ NO
-SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP_
❑ YES ❑ NO
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NEW RESIDENTIAL LINE
i N NON-RESIDENTIAL SIGN
TADD ❑ RETAINING
DEMOLISH WALL'
ALTER ❑ OR FILL EXCAVATE ❑ PENCE
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PRE - swim
REPAIR n INSP. POOL
PLAN CHECKED BYI
HIS SITE IS LOCATED IN 1
CITY OF EDMONDS. LOCAL
REMARKS
SHOULD BE CODED 31
DWELLING
UNITS
Fee
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Plan Check No ............ ........
BUILDING
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PROPOSED USE'
PLUMBING
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aPLOT PLAN (In cats Building setbacks, abutting streets)
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HEAT k GAS LINE
FENCE
SIGN
tRETAINING
WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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No.
TOTAL AMOUNT DUE
I hereby acknowledge that I have rend 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
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
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
Signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
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.)
810 ATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
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D CTOR'B NAT
DEPARTMENT
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OITY OF
Plan Check Fee
OND
EDM OND3
DATE
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NOTE: Applicant Subject to
PR 1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FILE
marquees, etc.) will require separate permission.
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RECORD OF IN'
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RECORD OF INSPECTIONSt to ,„ , ;,
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