670387.pdfUILDING DEPARTMENT
PERMIT APPLICATION
dAlds
Applicant Fill
inside Heavy Lines
NEW
I
RESIDENTIAL
GAS
LINE
L[q.
SIGN
FADD
FiWALL
RETAINING
ALTER
DEMOLISH
EXCAVATE
OR FILL
El
FENCE
( .......... x . ........ Ft.)
REPAIR
PRE -MOVE
INSP.
swim
POOL
-NUMBER OF
DWELLING
UNITS
UTURE OF WORK TO 13E DONE
I hereby acknowledge that I have read this application: that the In-
formation given In correct; and that I am the owner, or the duty allthar-
Ized agent of the owner. I ease 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 Workmen's Compensation Insurance.
NOTE: Permit Limit One Your (Except DE51OLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
NOYE: Applicant Subject to Plan Cbeck Fee
This Permit covers work to be done an private Property ONLY -
Any construction an the public domain (curbs, sidewalks. drIVOWAYS,
rujulluees, etc.) Will require separate permission.
EXISTING STREET R/W ............ FT -
COMP. PLAN ST. R/W ............ FT,
Plan Check No .....................
_-IFIRAWI�Lel
PLUBEBING
HEAT & 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
IN13PECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
PERMIT
N'UMBER,
DEFIOMCY THIS PROPERTY
13M5
APPLICATION APPROVAL
This application is not a permit - until
signid'1K)r.thie"'Building official or his Dep-
uty,"and fees are paid, and receipt is ac-
knowledged in space provided.
Z__
I . it