700443.pdfr
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� BUILDING DEPARTMENT Applicant Fill
UIL a Inside Heavy Lines
PERMIT APPLICATION I
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MAILING ADDRESS
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PERMIT
NUMBER, 700443
0 YES 0 NO
EXISTING I STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT.
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ZONE I TYPE OF
RESIDENTIAL
GAS El YES [] NO
LINE
NEW
I
I
PLAN CHECKED BY
El
NON-RESIDENTIAL
El
SIGN
ElADD
RETAINING REMARKS
F1DEMOLISH
F1
WALL
ALTER
EXCAVATE
OR FILL
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I
........
REPAIR
El
PRE-NIOVE
INSP.
E]
SWINT
POOL
rUMBER OF STORILS
NUMBER OF
DWELLING
UNITS
c k N G
Plan Check No .....................
I' 'a n C b
I N G
BUILDING
B U IL
'
L I N G
PLUMBING
P U
GA S LI N E
HEAT & GAS LINE
E
b T &
E L
PENCE
I 'C
SIGN
N
I
RETAINING WALL
N
.1
SWIMM - ING POOL
DEMOLITION
M
P M V I SP
PRE -MOVE INSPECTION
V TION 0
EXCAVATION OR FILL
CA
I hereby acknowledge that I have read this 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 amil state laws 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 DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six montheiii)
NOTE: Applicani Subject to Plan Check Fce
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
ATTE NTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 8-1107
BY
Valuation
STREET IMPROVI
0 YES 131-10
Fee
oil
APPLICATION APPROVAL
This application is not a perInit until
isigned by the BuLldIng Official or h1s Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
. !::;7 �
FILE
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