710499.pdfPOSTED ON KROLL MAP NO.: PERMIT'. -� - ��,
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BUILDING DEPARTMENT
Applicant FIn
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PERMIT APPLICATION.�
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NAME (OR
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TELEPHONE NUMBER
NAME
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STATE LICENSE NUMBER
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7CI RESIDENTIAL LINE
NEW T� LIN
NON-RESIDENTIAL ❑ SIGN
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ALTER ❑ EXCAVATE FENCE
LAIOR FILL � (.......... x.......... Ft.)
REPAIR ^ PRE -MOVE SWIM
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DWELLING
UNITS
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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
I 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
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
0 YES j NO C
HEI HT - I BUILDING AREA I VARIANCE MMBER P.
PLOT PLAN APPROVED
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STREET R/1V -
-
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EXISTING STREETR/W
............FT. DEFICIENCY THIS PROPERTY
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COMP. PLAN ST. R/W
............FT. ........FT.
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REMARKS
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I CFIECKED BY -
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METER SIZE SERVICE SIZE CLEARANCE"'
-CHECKED BY
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REMARKS
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TYPE CONNECTION I
VERIFIED BY-
PERC. TEST
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PERMIT NUMBER
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REMARKS -
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
❑ YES ❑ NO
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE
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REMARKS
CITY OF EDMONDS. LOCAL SALES
TAX SHOULD BE CODED 31.04.
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Valuation I Fee I Recelpt No.
Plan Check No .................
BUILDING
PLUMBING
HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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ATTENTION
APPLICATION APPROVAL
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THUS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
THE
uty; and fees are paid, and receipt is ac-
WORK NOTED
knowledged in space provided.
RE SQWNER OR 4GE DATE 816NED INSPECTION
_ �� DEPARTMENT
jj 11 CITY OF
EDAIONDS
NOTE: Applicant Subject to Plan Check Fee
PR a-110T
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, eta.) will regalre separate permission.
0
FILE
RECORD OF INSPECTIONS