690252.pdfBUILDING DEPARTMENT Applicant Fill
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PERMIT APPLICATION Inside Heavy Lines
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SIGN
RETAINING
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DEMOLISH
ALTER
EXCAVATE
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PENCE
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FILL
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REPAIR
PRE -MOVE
INSP.
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POOL
I NUMBER OF
DWELLING
UNITS
ED ON KROLL MAP N PERMIT
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NUMBER
(D90252
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REAR YARD SETBACK
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Plan Check No ............ ... ....
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Buildin tbac abutting Directs)
PLUZIBING
HEAT & GAS LINE
PENCE
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SIGN
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RETAINING WALL
SWIMMING POOL
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DEMOLITION
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PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I bereby acknowledge that I have read thin 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 mints laws regu-
ATTENTION
lating construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State u.� Washington
TIUS IVERMT
relating to Workman's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed in ninety days; AlOVED-IN BUILDINGS shall be com.
pj4ed In mix months.
, JvN4
AqNATURE kOWNhi
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ATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
1110101011—
EDMONDS
NOTE: Applicant Subject to P14H Check Fee
rn 6-1107
This Permit coven work to be done on private property UNLA.
Any construction on the public domain (cattle, 51deWOULN. drIVoWflY5,
marquees, etc.) will require separate permission.
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Fee
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.