680134.pdfIRMW avoivimsturnsine Appllcmt Fill
'kiiff APPLICATH Inside Iffeavy Unes
NAMN (OR NAME or BUSINESS)
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ElREPAIR
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OF
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RESIDENTIAL
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WON-RE81DENTIAL
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DEMOLISH
RETAINING
WALL
EXCAVATE
PENCE
on rim
( ...... x ... .... Pt.)
PRE -MOVE
INSP.
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POOL
DWELLING
UNITS
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I hereby acknowledge that I have read this application; that the in.
formation given IN Correct; and that I arn the owner, or the duly author.
lzed agent of the owner. I agree to comply with city and state laws regu-
latluK construction; and Lik 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 Year (EXCept DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUJ[LDINGS shall be OOM.
Plated In atz months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be dome an private Property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
EXISTING STREET R/W ... . . ... PT.
COUP. PLAN ST. R/W
0 YES 0 NO
YES
0 NO
DEFICIENCY THIS PROPERTY
[3 YES E3 NO
Fee
I
Check
BUILDING
0
PLUMBING
IMAT & GAS LINE
PENCE
IPlan
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PnEMOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE I I — 1/ .1
ATTENTION APPLICATION APPROVAL
THISPERMIT
AUTHORUMS This application Is not a permit until
ONLY THE signed by the Building Official or his Dep-
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION E AT
DEPARTMENT
CITY OF 64ones
EDMONDS DATE
PR 6.1107
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INN
1.
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