670513.pdf4
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BUILDING DEPARTMENT I Applicant MR
PERMIT APPLICATION inside Heavy Lines
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NON-RESIDENTIAL
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SIGN
1KADD
RETAINING
0
DEMOLISH
WALL
DALTER
7
EXCAVATE
on FILL
FENCE
( X rt.)
REPAIR
PRE-16TOVE
.......... ..........
SWIM
INSP.
POOL
TUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
PERMIT
NUMBER 670513
YES [3 NO
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. .......... 77.
OF
0 YES
Plan Check No .....................
Valuation
[3 YES
No.
BUILDING
0
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A31OUNT DUE
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 rellu.
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
TIUS PEIU%lIT
relating to Workmen's Compensation insurance.
AUTHOIUZES
NOTE: Permit Limit One Year (Except DE31OLITIONS which
ONLY THE
WORK NOTED
shall he completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In SIX months.)
SIGNATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDIWONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6.1107
This Permit covers work to be done on privuht property ONLY.
Any construction on the public domain (curbs. Sidewalks, driveways,
marquees, etc.) will require Separate pemilosion.
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.
DIRECTOR'S SIGNATU
FILE
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