700484.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
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CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
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REMARKS
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8 CIAL INSPECTOR REQUIRED
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PLAN CHECKED By
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DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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 -
feed 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 Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
IIGNATURE (OWNER Oft AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDAIONDS
NOTE: Aj)plicant Subject to Plan Check Fee
VR 6-1107
This Pernilt coven work to be dune an private property ONLY.
Any construction on (lie public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
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Valuation
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Fee I Receipt No,
16-1 " ( 5� " 9-
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
C-1 - --'I Q i
FILE
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