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BUILDING DEPARTMENT
PERMIT APPLICATION
Applicant Fill
Inside Heavy Lines
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GAS
RESIDENTIAL R
LINE
NEW ■NON-RESIDENTULL ■SIGN
■ •• ■RETAINING
■ DEMOLISH WALL
ALTER EXCAVATE PENCE
F1 OR PILL
■ REPAIR PRE -MOVE swi
■INSPI ■ ••
.UMBEIVIG"TORIES NUMBER
DWELLING
UNITS
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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
lzed agent of the owner. I agree 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 ComDensatlon Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
&hall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
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NOTE: Applicant ubject to Plan Check Fee
This Permit covers
work to
be done
oa Private Property ONLY.
Any construction on
the public
domain
(ourbs, sidewanu• driveways,
marquees,
etc.) will
require
separate permission,
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680092
EXISTINGSTREETR/W »..�_...5'T.
COMP. PLAN ST. R/W .._..»...pT.
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Plan Check No....»......_.._..
BUILDING 1"Zi7o
PLUMBING
HEAT do 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
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR d-1107
PERMIT 1
NUMBER .. .�
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[ YES 13 NO
No. I -
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APPLICATION APPROVAL �O
This application is not a permit until
Signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
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