670310.pdfi
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BUILUINU uerAK
,PERMIT APPLICJ
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DWELLING
UNITS
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I hereby acknowledge that I have read this application; that the in-
formation given 1s 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
will be employed in violation of the Labor Code of the State of Washington
relating to Worhtnea's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
plated in six months.) /
�O14AATURE (OWNER OR A ENT) i DATE SIO$ED
U NOTE: Applicant Subject to Plan Cho
This Permit covers
work to
be done
on private property ONLY.
Any oonstructlon on
the public
domain
(curbs, sldewalks, driveways,
marquees,
etc,) will
require
separate permission,
,
' � 670310Z:L
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8E ACK AR YAR!BETBAC*K'
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AREA VACANT SI
i
0 YES O
,DING AREA VARIANCE NUMBER
EXISTING STREET R/W ..»»....FT.
COMP. PLAN ST. R/W _....._...FT.
■ ■ '
MU Cheek No, ..........._...._.
BUILDING
PLUMBING
BEAT h 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 (1-1107
da dV 13�1� i
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APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or hie Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided
DIRECT 'S SIGNA U 'j
DATE i
67
FILE ! "�
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