680506.pdfBUILDING DEPA
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PERMIT APPLICATION
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RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
SIGN
DEMOLISH
RETAINING
WALL
E XCAVATE
FENCE
OR FILL
PRE -MOVE
INSP.
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POOL
DWELLING
UNITS
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POSTED ON KH LL MAP NO.. PERMIT
I NUMBER 0n=1
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-
ized 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!a Compensation Insurance.
NOTE: Permit Umit One Year (Except DE31OLITIONS which
$hall be completed in ninety days; MOVED -IN BUILDINGS shall be Com-
pleted irk six months.)
NOTE:
Check Fee
9
This P mdt covers work to be done on private property ONLY -
Any construction on the public domain (curbs, sidewalks, driveways,
msnueeg, etc.) win require separate permission.
KISThr6_ STREET R/W ........... FT.
COMP. PLAN ST. R/W ........... XT-
0 YES algo_�'
Plan Check No ............
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE.MOVE INSPECTION
EXCAVATION OR FILL
[3 YES E3 NO
DEFICIENCY THIS PROPERTY
Valuation
[3 YES
Fee
No.
TOTAL AMOUNT DUE -1/1746//
ATTENUON APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES Signed by the Building official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION D RLECTOWS 0 RATURE-
DEPARTM T
Crry or -
EDMONDS
PR
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