700413.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
'OTT
2 7"
11d
V
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or
k
RESIDENTIAL
0
GAS
LINE
NEW
I
ADD
NON-RESIDENTIAL
F1
SIGN
DEMOLISH
RETAINING
WALL
ALTER
EXCAVATE
FENCE
OR FILL
PRE -MOVE
Ft.)
swim
REPAIR
INSP.
El
POOL
NUMBER Or
DWELLING
UNITS
t
N
I
I hereby acknowledge that I have read thin 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 state lawn regui-
tating 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 Workmenlo 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.)
NOTE: Applicant Suffiect to Plan Check Fee
This Permit covers work to he none on private property ONLY.
Any construction on the public domain (curb@, sidewalks, driveways,
nuLrquees, etc.) will require separate permission.
EXISTING STREET R/W ............ FT.
COUP. PLAN ST. R/W ........ ... FT.
FIRE
[] YES [I NO
PERMIT
NUMBER, 700413
TE
Cl YES 0 NO
VARIANCE NUMBER
VACANT III
DEFICIENCY THIS PROPERTY
[3 YES 13 NO
R14W— 1-0 jV&j11.Y10A1,g
61-- QeAord7t -70 6)&f
A* .Olcc
Plan Check No ....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATMNTION
THIS PERMIT
AUTHORIZES
ONLY TIlE
WORIK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 6-1107
Valuation
Fee
Cl
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or Ids Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE
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