700301.pdf....... .. . ..
BUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME .(OR NAME OF BUSINE88)
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or
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NEW
FVI
v-, 1 RESIDENTIAL
1
F�
GAS
LINE
1:1
NON-RESIDENTIAL
SIGN
ADD
RETAINING
DEMOLISH
WALL
ElALTER
EXCAVATE
FENCE
OR FILL
( x Ft.)
REPAIR
PRE -MOVE
INSP.
.......... ..........
swim
POOL
DWELLING
UNITS
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I hereby acknowledge that I have read this application; that 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 lawn 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 DE51OLlTIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction an file public domain (curbs, sidewrOksp drlvewaysp
marquees, etc.) will require separate permission.
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EXISTING STREET R/W ............ FT -
COMP. PLAN ST. R/W ............ M.
[] YES
REMARKS
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Plan Check No ............
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
PERMIT
NUMBER
70030
[:] YES C] 740
DEFICIENCY THIS PROPERTY
........... I'm
Valuation
[] YES 0 I -TO
Fee
TOTAL AMOUNT DUE
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ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a pernilt until
AUTHORIZES
signed by the Building official or his Derl-
ONLT THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
INSPECTION
DIRECTOR'S SIGNATURE
DEPARTMENT
CITY OF
DATE
EDMONDS
PR 0-1107
FILE
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