700202.pdfC
BUILDING DEPARTMENT
PERMIT APPLICATION
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Applicant Fill
Inside Heavy Lines
MA
NEW
RESIDENTIAL
GAS
LINE
NON-REBIDENTIAL
SIGN
RETAINING
WALL
DEMOLISH
ALTER
EXCAVATE
OR FILL
PENCE
Irt.)
.........
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
V
C
&P NO.;
PERMIT
NUMBER
YES (3 NO
CI&ING'STREET R/W ... . ...... FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. n/W ....... ... XT- ........... in.
0 YES 0 NO
Mu Check No .................
BUILDING
PLUMBING
HEAT & GAS LINE
tRETAINING
PENCE
SIGN
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL &MOUNT DUE
0 In
I hereby acknowledge that I have read this application; that the In-
'
th 0 r
formation given Is correct; and that I am the owner, or the duly author.
'U
e u
ized agent of the owner. I agree to comply with city and state, laws regu-
:
ATTENTION
r on
latlng construction; and in doing the work authorized thereby, no person
1pe gton
will be employed in violation of the Labor Code of the State of Washington
TMS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
shall be edmpleted in rdnety days; MOVED -IN BUILDINGS shall be oone-
pleted In six months.)
SIGNED
TURE (0 R OR A,"Nq DATE rj
INSPECTION
6
77 2— —Z V —76
DEPARTMENT
trele-l-&eE
CITY OF
EDMONDS
NOTMIAPPficant Subject to Plan Check Fee
PE 6_1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbsp sidawalksp driverwayss
m&rqucc@, ete.) wiu require separate permission.
ALWI
13 YES 13 NO
IOUP
't
I 1=�_ - - I :5-V4 /I
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 so
knowledged in space provided.
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