700223.pdfBUILDING DEPARTMENT I AppItcantFill
PERMIT APPLICATION Inside Ifeavy Linea
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CITY TELEPHONE NUMBER
8 STATE LICENSE NUAIBER CITY LICENSE NUMBER
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Legal Description of 7roperty (Show Below or Attach Four Copies)
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RESIDENTIAL GAS
❑ LINE
NEW
NON-RESIDENTIAL a SIGN
ADD ElAINING
DEMOLISH ❑ WALL
ALTER El On FILL EXCIVATE F CE ..xLb. t.)
REPAIR PRE -MOVE ^'swim
F�INSP, I { POOL
DWELLING
UNITS
1
I hereby Leknowledge that I have read this 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 stale 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.)
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NOTE: Applicant Subject to Plan Check Fee
Thee Permit coven
work to
be done
on private property ONLY,
Any constraclion on
the public
domain
(turbe,
sidewalks, driveways,
marquees,
etc.) will
require
separate
permission,
NO,: I PNUMBER 700223
- I 1 I 1 ❑ YES
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EXISTING STREET R/W ,...........FT. DEFICIENCY THIS PROPERTY
❑ YES ❑ NO
Plan Cheek No, ....... _........
BUILDING
A1ft_WTAJ_ NLP
HEAT do GAB LINE
FENCE
SIGN
RETAINING WALL
1.114 f'i' 1iN[e-f•I.1.1!
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORN NOTED
INSPECTION
DEPARTMENT
CITY OF
EDBfOND$
PR d-1107
YES ❑ NO
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APPLICATION APPROVAL
This application is not a permit Lentil
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is Rem
Imowiedged in space provided.
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