690186.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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PLOT PLAN (Indicato Building setbacks, abutting streets)
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I N"UMBER 690186
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MMARKS
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PERMIT NUMBER
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Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
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SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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 uuthor-
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's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
'NOTE: Applicant Subjeri to Plan Check Fee
This permit covers work to be lone on private property ONLY.
Any construction on the Public domain (cuths, sidewalks, driveways.
marquees, etc.) will wequire separate permission.
Valuation
RwIlIF7,00742",
No.
TOTAL AMOUNT DUE o
ATTENTION APPLICATION APPROVAL --..-
THIS PERMIT This application is not a permit until
AUTHORIZES
ONLY TIM signed by the Building Official or his Dep-
WORK NOTED uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
INSPECTION DIRECTOR'S IGNAT
DEPARTMENT
CITY OF
EDAZONDS
PR 6-1107
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