710422.pdfBUILDING DEPARTMENT®
PERMIT APPLICATION
NAME (OR NAME OF BBU-SINESS)
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MAILING ADDRESS
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CITY
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STATE L
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RA
I Jul NEW
ADD
ALTER
REPAIR
N
or
Applicant Fill
Inside heavy Lines
® RESIDENTIAL ❑ GAS
LINE
NON-RESIDENTIAL ❑ SIGN
❑RETAINING
DEMOLISH El WALL
❑EXCAVATE ❑ FENCE
OR FILL (.......... x.......... Ft. )
PRE -MOVE SWIM
INSP. POOL
L MAP NO.;
7 n tL
1 PERMIT 710422
NUMBER
I
❑ YES ❑ NO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
❑ YES ❑ NO
DWELLING
UNITS
NATURE ORK TO BE DONE
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Gam'
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Plan Check No .....................
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BUILDING
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PROPOSED UBE
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PLUMBING
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a
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LIN
FENCE
SIGN
RETAINING WALL
N
ISWIMMING
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given In correct; and that I am the owner, or the duly author-
Izcd agent of the owner. I agree to comply with city and elate ]awe regu-
ATTENTION
lating construction; and in doing the work authorized thereby, no person
will be employed 1n violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
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DEPARTMENT
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7-�
CITY OF
EDMONDS
NOTE: Ahplic n Subject to Plan Check Fee
PR a-uov
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sldewalks, driveways,
marquees, etc.) will require separate permission.
STREET
❑ YES
❑ No
CITY OF EDMONDS. LOCAL
Valuation I Fee
.0
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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RECORD OF INSPECTIONS
Date Passed
Foundation
plumbing (Partial) //
(Rough)
Frame
Furnace & Fuel Lines------
F Final --
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RECORD OF INSPECTIONS
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� Date Passed
Drainage
Sewer ..,
Parking . —
Landscaping
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Fire Dept. i-------
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