680524.pdfBUILDING DEPARTMEN
PERMIT APPLICATION
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RESIDENTIA
E,
GAS
LINE
NEW
NON-RESID1 NTrAL
F_j
SIGN
RETAINING
DEMOLISH
WALL
ALTER
EXCAVATE
OR FILL
PENCE
( x Ft.)
REPAIR
PRE -MOVE;
INSP.
........ . .......
SWIM
POOL
FUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
I hereby acknowledge Mat I have read this application; that the In.
formation given to correct; and that I am the owner, or the duly author.
lied 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 Workman's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
&hall be completed in ninety days; MOVEDAN BUILDINGS ahall be cum.
plated In six months.)
NOTE: Applicant Subject to Plats Check'Fee
This Perma coven work to be done an private property ORTY7
Am construction on the public domain (curbol sidewalks$ driverwalat
maNueen, etc.) will require separate permlealon.
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EX38TING STREET R/W
COMP. PLAN ST. R/W ........ .. J"-
FIRE ZONE I TYPE
13 YES [3 NO
PERMIT
NUMBER
680524-
M
=OK
13 YES E3 NO
DEFICIENCY THIS PROPERTY
...... _.J".
YES Cl NO
Valuation
Fee
Receipt No.
Plan Check No .......
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTrJMON
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 6-1167
N
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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