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Ilk% BUILDING DEPARTMENT Applicant Fill
PERMITAPPLICATION Inside Heavy Lines JOB ADDRESS
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Q
NEW
E] RESIDENTIAL
1
R
GAS
LINE
1:1
NON-RESIDENTIAL
F-1
SIGN
r_1 AV�
RETAINING
DDEMOLISH
WALL
ALTER
M
EXCAVATE
OR FILL
FENCE
( x Ft.)
.......... ..........
REPAIR
F_j
PRE -MOVE
INSP.
swim
POOL
NUMBER OF
DWELLING
UNITS
PERMIT
NUMBER
[3 YE13 [3 NO
EXISTING'STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
"T.
COMP. PLAN ST. R/W ............ FT. ............
REMARKS
FIRE ZONE
0 YES 0 NO
REMARKS
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
I
tRETAINING
WALL
N
—
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the In-
formation given to correct: and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state lawn regu-
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Coda of tho State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONH which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
E: Applicavnt Object to Plan Check Fee
This permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, aldewalks, driveways,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
[] YES [] NO
Valuation I Fee
FA
No.
ilrt(jo�z I ___
APPLICATION APPROVAL
This application is not a permit until
eigned by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
lmowledged in space provided.
FILE
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