710018.pdfBUILDING DEPARTMEN
PERMIT APPLICATION
NAME
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Applicant Fill
Inside Heavy Lines
.� NEW
RESIDENTIAL
LINE
ADD
NON-RESIDENTIAL
❑ SIGN
❑
DEMOLISH
KING
� RETAINING
E
EXAVATE
FENCi
ALTER
ORCFILL
El Ft.)
..........
REPAIR
INSPMOVE
El POOL
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DWELLING
UNITS
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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 and 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 months.)
Applicant Subject to Plan Check Fee
Till 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.
V
NO.: PERMIT
NUMBER
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
❑ YES ❑ NO
Plan Check No .....................
BUILDING
73 A v7 iiP
HEAT & OAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
1•);,i�t•)�1Y�C•�
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR g-1107
710018
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REAR YARD SETS
VACANT SITE
❑ YES ❑ NO
DEFICIENCY THIS PROPERTY
❑ YES ❑ No
Valuation I Fee
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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-
knowledged in space provided.
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JG RECORD i?F INSPECTIONS
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