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UILDING DEPARTMENT Applicant Fin
PERMIT APPLICATION Inside Heavy Lines
IAMM l
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TELEPHONE NUMBEI
772-::�/z
CITY LICENSE NUMB
or Attach Four Copies)
NEW
a RESIDENTIAL
GAS
LINE
"'777""���
NON-RESIDENTIAL
❑
SIGN
ADD
❑
RETAINING
DEMOLISH
EXCAVATE
FENCE
ALTER
❑
❑
Ft.)
REPAIR
ElINSP.
PRE -MOVE
.7t_........
swim
POOL
DWELLING
UNITS
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.
P Limit One Year (Except DEMOLITIONS which
all e c Dieted n ninety days; MOVED -IN IIOiLDIN08 shall he com-
plet In Ix mon s.)
BI ATU V(OR OR AGENT) DATE BION D
7
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the Dublin domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permisslen.
C_
1�4/1- 8
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
YES
REMARKS
Plan Check No .....................
i Im"03 R ,
PLUMBING
HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
PERMIT 710051
NUMBER
ACK I REAR YARD SETBACK
O
YE T BIT
[3 NO
DEFICIENCY THIS PROPERTY
............FT.
Valuation
i] YES NO
Fee
I
R`,
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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RECORD OF INSPECTIONS ; ,
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