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BUILDING DEPARTMENT
PERMIT APPLICATION
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(OR OF LNmen)
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Applicant Fill
Inside Heavy Idnes
1 N NEW
Ip RESIDENTIAL
GAS
LINE
Tr"
NON-RESIDENTIAL
❑
SIGN
ADD
NINE
RETAINING
❑
DEMOLISH
ALTER
❑
ORCPILL E
ElFENC.x
Ft.)
REPAIR
PRE -MOVE
INSP.
M
..........
swim
POOL
DWELLING
UNITS
I hereby acknowledge that I have read this application; that the In-
formation given to 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 to doing the work authorised thereby, no person
will be employed in violation of the Labor Code of the State of Washington
relating to Workman's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed to 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, sidewanu, driveways,
marquees, eta.) NW require separate permission.
' NO.; I PERMIT
NUMBER
S- I Z
EXISTING STREET R/W
COMP. PLAN ST. R/W
SUgV Z-- G1D
0 YES ❑ NO
Plan Check No ................
st
71
Fl
YES Q No
Q YES ❑ NO
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THIS SITE IS LOCATED IN THE
TAX SHOULD BE CODED 31.04.
BUILDING
h�
d'
�0 9
PLUMBING
�O '�
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
PH e-1107
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.
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RECORD OF INSPECTIONS Sy
\
Date Passed
' Foundation
Piumbing
Par
till AAAAl
vvv�
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(Rou h)
F. r
`,. Frame
_. Furnace &Fuel Lines
Final
RECORD OF INSPECTIONS
kj Date Passed
r .h r _. ,
, Drainage ait
Sewer
` Parkingoll- ^a`
I Landscaping
,F.ire Dept.
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