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FB U ILDING DEPARTMENT Applicant Fill
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R!J! Inside Heavy Lines
ERMIT APPLICATION
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NWAMMLONE NUMBEE
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NAME
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NAME
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ADDRESS
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TELEPHONff NUMBE
STATE LICENHIS NUMBER
CITY LICENSE NUhU
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RESIDENTIAL
GAS
LINE
NEW
NON-RESIDENTIAL
SIGN
ADD
RETAINING
WALL
DEMOLISH
F� ALTER
EXCAVATE
D OR FILL
El
FENCE
( ........ . X ..... .... Ft.)
REPAIR
PRE -MOVE
SWIM
POOL
INSP.
NUMBER OF
DWELLING
UNITS
RATURE OF WORK TO 33E DONE
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N KROLL MAP NO.*. PERMIT 680337
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EC138
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=OUT
R/W .4.0.FT. DEFICIENCY THIS PROPERTY
COMP.
indicated on - Standard Drawing #103.
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TYPE OF
Plan Check No ............ ... ....
PROPOSED USE
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BUILDING
'5� " i- I, - -
PLUMBING
PLOT PLdLN (Indicate Building setbacks, abutting streets)
BEAT & GAS LINE
PENCE;
t
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; and that I am the owner, or the duly author.
Ited agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the work authorixed thereby, no person
ATTENTION
will be employed in violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Urnit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted in nix months.)
INSPECTION
DEPARTMENT
S ON URE (OWNERL
TE SIGNED
-68'
CITY OF
EDMONDS
NOTE: Applicant Subject to Plats Check Fee
PR 0-1107
This rermit covers work to be done on private Property ONLY -
Amy construction on the public domain (curbs, sidewalks, driveways,
nutrquees, etc.) will require separate permission.
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Fee
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15 3 - 0 10 1
;k
No.
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and eees are paid, and receipt is ac-
lanowledged in space provided.
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