700419.pdf01
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Reavy Lines =OB
DRESS
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CITY TELEPHONE NUUBI
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or
NEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
SIGN
DEMOLISIT
RETAINING
WALL
EXCAVATE
FENCE
ALTER
OR FILL
( Ft.)
PRE-14OVE
........ . x ..........
swim
REPAIR
INSP.
POOL
DWELLING
UNITS
t
N
I
I hereby acknowledgo that I have read this applicatlon: 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 rogu.
toting 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; MOVEDAIN BUILDINGS shall bo com-
pleted In six months.)
NOTE: APPlicant Subject to Plan Check Fee
This Permit covers work to be done an private property ONLY.
Any construction on the MIMIC domain (curbs, sidewalks, drIVOWILYS,
marquees, etc.) will require separate permission.
EXISTING STREET n/w ............ FT.
COMP. PLAN ST. n/w ............ FT.
C] YES [] NO
REMARKS
Plan Check No .................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
AT17ENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
PIt 6-1107
[3 YES [3 2,10
DEFICIENCY THIS PROPERTY
............ I.V.
0 YES
Valuation
E
[] NO
APPLICATION APPROVAL
94
No.
This application is not a pernat until
signed by the Building Official or Ws Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
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