710076.pdf3
BUILDING DEPARTMENT
,,-.PERMIT APPLICATION
II, NwM>;s
Applicant Fill
Inside Heavy Lines
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or Attach
'❑ RESIDENTIAL
❑ NEW
❑
NONRESIDENTIAL
❑ ADD
❑
DEMOLISH
ALTER
El
OR FILL
OR
❑ REPAIR
❑
PRE -MOVE
INSP.
NUMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
[ fj
GAS
LINE
LINE
ElSIGN
oRETAINING
WALL
ElFENCE
(.......... x.......... Ft. )
SWIM
1 l
POOL
PERMIT 7
NUMBER 10076
-/Ql '�Pj 5-W,
YES ❑ NO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
YES ❑ NO
OF
67,9Y /C,:�l
Plan Check No .....................
BUILDING
[[0
q PROPOSED USE
a
PLUMBING
U
aPLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT A GAS LINE
n
FENCE
SIGN
tRETAINING
WALL
N
ISWIMMING
POOL
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-
Ized 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 TIQS 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.) --�
BIGN T (OW R OR AOE T) DATE SIGNED INSPECTION
DEPARTMENT
/71 CITY OF
EDIIIONDS
NOTE: Applicant Subject to Plan Check Fee
rR a-IIo'r
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curb&, sidewalks, driveways,
marquees, etc.) will require separate permission.
STREET IMPROVED
❑ YES ❑ NO
Valuation I Fee
R0
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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