680037.pdf1�0
BUILDING DEPARTMEN
PERMIT APPLICATION
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Applicant FM
Inside Heavy Lines
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EMSTING'STREET R/W ......... IT.
COMP. PLAN ST. R1W .... ...... Jrr.
PERMIT
NUMozR 680
13 YES 0 NO
DEFICIENCY TRIS PROPERTY
SVV50MENBID RUUER CITY LICENSE NUMBER 111
REMARKS
I gal Dewription � Below or Attach Copies)
Of Property (show
TYPE CONNECTION VEHIMMIJ BY
PERC. TEST PERMIT NUMIMIt
REMARKS
DIRESIDENTIAL
1:1
GAS
LINE
El NEW
1 11 No
SIGN
ADD
RETAINING
E]
0
WALL
EVALT=
DEMOLISH
EXCAVATE
OR rim
FENCE
33t.)
I
. ........
r_n_.-�
L_:[ REPAIR
PRE-MOVIC
SWIM
POOL
INSP.
NUMBER OF STORMS
NUM—BER oir
DWELLING
UNITS
Ing streets)
I hereby acknowledge that I have read this application; that ths In-
formation given is correct; and that I am the owner, or the duly author -
lead agent of the owner. I agree to comply with city and state laws regu-
lating construction; &W to doing the work authorized thereby. no person
will be employed in violation of the Labor Code of the State of Washington
relating to WorkmeWX Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
mhall be completed In ninety days; MOVED -IN BUILDINGS shall be oom-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This permit oovws week to be done On private Property ONLY -
Am construction an the public domain (carbs, sidewlaks, driveways,
marquees, etc) will require separate Permission -
[3 YES [3 NO
Plan Check
BUIMING
PLUIMING
BEAT a GAS LINE
PENCE
SIGN
RETAINING WAIJ-
SWIMMING POOL
DEMOLITION
PRE.MOVE INSPECTION
imccAvAvoN OR FILL
TOTAL AMOUNT DUE
ATTENTION
TWS PERMIT
AUTHORLZES
ONLY TIUC
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
Pa 6-1107
YXIS 13 NO
Fee
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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