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1 —BUILDING DEPARTMENT Applicalit Fill
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I PERMIT APPLICATION 71de Heavy Lines JOB ADDRE138
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REMARKS
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RETAINING TTN�X
WALL
DEMOLISH
DALTER
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EXCAVATE
OR FILL
PENCE
( .......... x ......... rt.)
DREPAIR
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PRE -MOVE
SWIM
POOL
INSP.
NUMBER OF STORIES
NU MBER OF
1 DWELLING
UNITS
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TO BE DONE
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PROPOSED USE
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PLUMBING
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SIGN
RETAINING WALL
SWIMMING 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; end that I aco the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regU-
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 WaAhington
TMS PERMIT
r0lating to WorkmeWs Compensation Insurance.
AUTHORIZES
ONLY TILE
NOTE: Permit Limit One Year (Except DE51OLITIONS which
WORK NOTED
shall be Completed in ninety days; MOVEDIN BUILDINGS shall be 0010-
plated In six months.)
_—IT)AWE
INSPECTION
81GNED
IIGN
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subiccl to Plat; Chcck Fcc
PR 0-1107
T�j_s —remat covers work to be done on private properly UA�X.
Any construction on the PUbtle domain (ClUbS, sidewalks, driveways.
marquees, ate.) will require separate permission.
[] YES [3 NO
Fee I Receipt No.
1;
07?-7S� 4010
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or Ills Dep-
uty; and fees are paid, and receipt Is ac-
lfnowledged�in space provided.
D—=CTOWS SIGNATURE
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