700339.pdfPOST
BUILDING DEPARTMENT Applicant Fill 9
Inside Ifeavy L11nes —
PERMIT APPLICATION
OF B
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SIGN
ElADD
EJDEMOLISH
RETAINING
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EXCAVATE
FENCE
ALTER
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ED
( x Ft.)
El REPAIR
1:1
PRE -MOVE
INSP.
.......... ..........
swill
POOL
IUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
FR—OLL MAP NO
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S_
PERMIT
NUMBER
700339
13 YES 0 NO
EXISTING STREET n/w ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT. ............ FT.
FIR�E �Zo
TYPE OF
SPECIAL INSPECTOR RE
[3 YES
YNO
rim
RIO
Plan Check No .....................
BUILDING
PLUMBING
HEAT
FENCE
SIGN
1EXCAVATION
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
OR FILL
TOTAL AMOUNT DUE
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 laws regu.
ATTENTION
lating construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Coda of the State of Washington
THIS PERMIT
relating to Workmen's Cotnpenaation Insurance.
AUTHORIZES
TE P r I t Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
, jha b pi te In) ninety days; BIOVED-IN BUILDINGS shall be com.
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c, X Me7
le ed lei A
P ple ths.
110NATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Stibject to Plats Check Fee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewniks, driveways,
marquees, etc.) w.11 require separate permission.
Valuation
0 YES
Fee
M
Aej
M
No.
APPLICATION APPROVAL
This application Is not a perralt until
signed by the Building Official ur his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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