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Inside Iieavy Linos
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RESIDENTIAL
GAS
LINENEW
NON-RESIDENTIAL
SIGN
ElADD
❑
ALTER
❑
DEMOLISHWASTANG
FILL EXCAVATE
OR FILL
❑
FENCE
`.x..........Ft.)
REPAIR
PRE -MOVE
INSP.
swim
POOL
DWELLING
UNITS
I
N
I
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 to doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Perini imit One Year (Except DEMOLITIONS which
sll a comDle !n nely days; MOVED -IN BUILDINGS shall be com-
Dletc In six onths.
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the pubne domain (curbs, sidewalks, drlvewa7e,
nuurquees, etc.) will require separate permission.
1 --
A p,
NO.: PERMIT
I NUMBER 7 1054 C ..._
I
STREET SETBACK I REAR YARD SETBACK
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............ FT,
OF
YES Ej NO
O YES ❑ NO
DEFICIENCY THIS PROPERTY
............FT.
YES 0 NO
THIS SITE IS LOCATED IN THE
REMARKS C:: f.l.., I`. _ _.. .
TAX SI—IOU! i3 G :, D 31.04.
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
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR s-1107
Valuation
Fee
(i
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.
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i Final
RECORD OF INSPECTIONS
-pate Passed
Drainage
Sewer
Parking
r
Landscaping
Fire. Dept.
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