710469.pdfBUILDING DEPARTMENT I Applicant Fin
PERMIT APPLICATION Inside Heavy Linea
u RESIDENTIAL ❑GAS
LINE
NEW ❑ NON-RESIDENTIAL
s1aN
ADD I'�j^p-�' DEMOLISHWALL
NING
ALTER ❑ EXCAVATE ❑ FENCE
OR FILL (......... A .......... Ft.)
REPAIR j''� PRE -MOVE ^ swim
f ` INSP. ' ` POOL
DWELLING
UNITS
- A ti
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-
ised 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 Coda of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
0
NOTE: Applicant Subject to Flan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
EXISTING STREET R/W ......-....FT.
COMP. PLAN ST. R/W ............FT.
❑ YES ❑ NO
Plan Check No ................
IA_ 00d DJQLC
PLUMBING
HEAT do GAS 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
PH a-1107
PN>�EER 710469
❑ YES I& NO
DEFICIENCY THIS PROPERTY
❑ YES ❑ NO
CITY OF EDMONDS, LOCAL
Valuation
Fee
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APPLICATION APPROVAL
No.
14
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.
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RECORD OF INSPECTIONS'
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Date Passed
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'# Foundation
Plumbing (Partial)
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Furnace & Fuel Lines
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APPLICATIC-A & WORK PERMIT
Application NQD:...•,�<..:.....f�T.l�� ?
x 3r CITY OF EDMONDS Building Department Permit Limit, One Year
APPLICATION is hereby made for a permit to construct the following work, in accordance with the accompanying plans
and specifications:
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WORK —New/Adds. ; L� sL,I ��L6..:-�Area................................... No. 3tories.QS,.,
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rr�, Plans Submitted :.............................................................................. ....................... Cons .Type........................................ Height....................... �
LOCATION ....S4.c...4,9 O. ........... Use Zone.R..6 ....... Fire Zone ..... ..........
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Recorded Lot ...... ....... Block :: cx?......... Add' .. /i �. 1............... Sewerage................................... s
Lot Area ........................................ Width. ........................... Min. Bldg. Setbacks, Front and Rear ............................... Sides.............................:
Plans
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Address........................................................................ Phone...... .................
Address ........................... ............. Phone... 7
- - _ Address ............................................... G ......... ...... ......... _....... k
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Plbg. by............................................................................................ Address ........................................................................ Phone...::. ................
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Heatingby................................................................................. Address ......................................................................... Phone...... ......:.: i
Elect. by ......... ............................................................. Address ........................................................................ Phone.................................
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Remarks...................................................................................................................................................................................... .....• .......
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............................................................................................................................................................................... ..................... ................. .
........................ ..... ..................
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.......................... .................... ......
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The above is a correct statement and i agree to comply with all applicable Codes and State Laws regulating the work. '
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Signed: Owner/.
l
Address............................................................................ Dat a?.. Y� I
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the approved plans '
and specifications and Building Department notations thereon.
VALUATION PERMIT FEES j
:...A_..........
$........................................
APPROVED: �f
Date....s?.-... �j� .. .......................
Bldg. .... $..... .l.Q.Z?..........
Plbg. ....$........................................
Heat....$........................................
Elect. ....$........................................
BUILDING DEPARTMENT Others ...$........................................
TOTAL FEE
NOTES: No work requiring Building Department or City Engineer's inspection shell be covered before inspection and approval. ! j
Twenty-four (24) hour notice requested. Contact the City Engineer prior to construction of all site utilities, such as l
curbs, paving, driveways, sewer, water and street connections. j
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