710068.pdfBUILDING DEPARTMENT I Applicant Fill
PERMIT -APPLICATION Inside Heavy Lines
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NEW
RESIDENTIAL
�
GAS
LINE
❑
NON-RESIDENTIAL
❑
SIGN
ADD El
NINE
RETAINING
_❑
IXI
7-'
ALTER EXCAVATE
OR FILL
FENCE
(..........x..........Ft.)
PRE -MOVE
REPAIR ❑ INSP.
swim
POOL
DUMBER OF STORIES
NUMBER OF
DWELLING
4
UNITS
4
MAP NO.:
PERMIT
NUMBER
USE S uw ........
�YE8____ _°_NO_
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPER
TY
COMP. PLAN ST. R/W ............FT. ............FT.
YES NO
-r Plan -Check No .....................
BUILDING
PLUMBING
HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
N
ISWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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 lewd 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 co[/pleted in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In el& month
NOTE: Applicant Subject to Plats Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivewa7s,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
Valuation
YES 0 NO
Fee
SO°
3
No.
!� , o -01&6)1) �
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.
DATE
FILE
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