670326.pdfIII
POSTED ON KROLL MAP NO.:
670326.
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�.�BUILDING DEPARTMENT AppBeant FIR
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PERMIT APPLICATION
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NAME (OR NAME OF
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GAS
RESIDENTIA LINE
-PLAN CHECKED BY
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NEW
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NON-RESIDE�LNTIAL SIGN
ADD RETAINING
WALL
DEMOLISH
ALTER EXCAVATE FENCE
D OR FILL El ( .......... X .......... Ft.)
PRE -MOVE SWIM
REPAIR F-1 INSP. POOL
NUMBER OF BTOIUE13 NU R OF
DWELLING
UNITS
NATURE OF WORK TO BE D:N
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Valuation
Fee RecelPt
No.
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
It
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this UP1311CMIJon; 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 rogu-
ATTENTION
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
THIS PERMIT
relating to WorkmeWs Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed In ninety daYS; MOVED -IN BUILDINGS shall be com-
pleted in mix months.)
INSPECTION
3IGNATURE (OWNER 6W AGE DATE SIGNED
DEPARTMENT
CITY OF
EDIMONDS
NOTE: Applicaid Subject to Plan Check Fee
PR 6.1107
This Permit covers wark to be done on private Property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) Ivill require sepamtO Permission-
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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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