700065.pdft
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BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION I Inside Heavy Lines
NEW
Ix RESIDENTIAL
El
GAS
LINE
ELINON-RESIDENTIAL
I
D
SIGN
ADD
RETAINING
WALL
DALTER
DEMOLISH
PENCE
EXCAVATE
OR FILL
REPAIR
El
PRE -MOVE
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avirlm
INSP.
POOL
e
DWELLING
UNITS
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I hereby acknowledge that I have read thin application; 1hat the In.
formation given In 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's Compensation Insurance.
NOTE: Permit Limit One Year (Except DE3101ATIONS which
shall be cempleted In ninety days; BIOVED-IN BUILDINGS shall be com-
pleted In six months.)
V1,2�-2, -, I , —, 70
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NOTE: Applicant Subject to Plan Check Fee
Title Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbol 0dowalike, drivewayst
ma.rquees, etc.) win require sepsrate permission.
1 IOSTED ON HROLL MAP NO.: PERMIT 700065
1 NUMBER
JOH ADDHESS
YARD
EXISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ FT.
C3 YES 0 NO
Plan Check No ...........
BUILDING
PLUMBING
BEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
1:1 YES
DEFICIENCY THIS PROPERTY
............ FT.
Valuation
M
STREET
[] YES
71W
[] NO
I W
G
Z
W
I
to
No.
TOTAL AMOUNT DUE
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
WORH NOTED uty; and fees are paid, and receipt is ac-
I knowledged in space provided.
INSPECTION DLRECTOR'S SIGNATUJU4
DEPARTMENT
CITY OF �4,1 �v " W—, I
EDMONDS
FR 6-1107 0.
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